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Zhao C, Zhao Y, Li J, Li M, Shi Y, Wei L. Opportunities and challenges for human papillomavirus vaccination in China. Hum Vaccin Immunother 2024; 20:2329450. [PMID: 38575524 PMCID: PMC10996835 DOI: 10.1080/21645515.2024.2329450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
Current estimates of the HPV infection rate in China vary by geographic region (9.6-23.6%), with two age peaks in prevalence in women ≤20-25 years of age and 50-60 years of age. HPV-16, 52 and 58 are the most commonly-detected HPV genotypes in the Chinese population. In China, five HPV vaccines are licensed and several others are undergoing clinical trials. Multiple RCTs have shown the efficacy and safety of the bvHPV (Cervarix), Escherichia coli-produced bvHPV (Cecolin), Pichia pastoris-produced bvHPV (Walrinvax), qvHPV (Gardasil) and 9vHPV (Gardasil-9) vaccines in Chinese populations, including two studies showing long-term efficacy (≥8 years) for the bvHPV and qvHPV vaccines. Real-world data from China are scarce. Although modeling studies in China show HPV vaccination is cost-effective, uptake and population coverage are relatively low. Various policies have been implemented to raise awareness and increase vaccine coverage, with the long-term aim of eliminating cervical cancer in China.
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Affiliation(s)
- Chao Zhao
- Gynaecology, Peking University People’s Hospital, Beijing, China
| | - Yun Zhao
- Gynaecology, Peking University People’s Hospital, Beijing, China
| | - Jingran Li
- Gynaecology, Peking University People’s Hospital, Beijing, China
| | - Mingzhu Li
- Gynaecology, Peking University People’s Hospital, Beijing, China
| | - Yujing Shi
- MRL Global Medical Affairs, MSD China, Shanghai, China
| | - Lihui Wei
- Department of Gynecology and Obstetrics, Peking University People’s Hospital
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2
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Noor Mohamad NA, Omar J. Cervical cancer in Malaysia. J Obstet Gynaecol Res 2024. [PMID: 39030916 DOI: 10.1111/jog.16031] [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: 04/30/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024]
Abstract
Cervical cancer is preventable due to effective screening to detect pre-malignant lesion, and vaccination against its causative organism namely human papillomavirus (HPV). This review article described current situation of cervical cancer in Malaysia. There is decreasing cervical cancer incidence in the country, with age-standardized rate of 10.3, versus 14.1 and 7.5 per 100 000 for worldwide and high-income countries, respectively. School-based HPV vaccination is part of national immunization since 2010, with yearly coverage rate of 83%-91%. The figure declined during coronavirus disease-19 pandemic due to scarce vaccine supply and movement-control order, resulting in about 500 000 students missing their course, with catch-up program currently onboard. Opportunistic cervical screening program started in 1960s with cervical smear cytology, which is succeeded by HPV DNA screening since 2020. Cervical cytology remains indispensable screening method in healthcare facility without access to HPV test kit, and used to triage high-risk HPV positive with abnormal cytology that require urgent colposcopy. Computed tomography is the main imaging modality to assess local and distal extent of cervical cancer. Primary surgical treatment for early-stage cancer is performed by trained gynecologic oncologist, with long waiting list for radiation therapy in locally advanced disease due to limited available public facility. There is restricted access to targeted therapy due to high treatment cost. In conclusion, Malaysia is heading toward cervical cancer elimination through rigorous investment in primary and secondary prevention, and increase in public engagement with the support of government policy enforcement.
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Affiliation(s)
- Noor Azura Noor Mohamad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Jamil Omar
- Department of Gynecologic Oncology, National Cancer Institute, Putrajaya, Malaysia
- Ministry of Health, Putrajaya, Malaysia
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3
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Davis BM, Blake I, Panicker G, Meites E, Thompson G, Geis J, Bruden D, Fischer M, Singleton R, Unger ER, Markowitz LE, Bruce MG. Immunogenicity of quadrivalent human papillomavirus vaccine among Alaska Native children aged 9-14 years at 5 years after vaccination. Vaccine 2024; 42:3277-3281. [PMID: 38627144 PMCID: PMC11285007 DOI: 10.1016/j.vaccine.2024.04.033] [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] [Received: 05/08/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Persistent human papillomavirus (HPV) infection can cause anogenital and oropharyngeal cancers. Many HPV infections and HPV-associated cancers are vaccine-preventable. Studies suggest long-term persistence of vaccine-induced antibodies. However, data are limited among Alaska Native people. METHODS During 2011-2014, we enrolled Alaska Native children aged 9-14 years who received a 3-dose series of quadrivalent HPV vaccine (4vHPV). We collected sera at 1 month and 1, 2, 3, and 5 years post-vaccination to evaluate trends in type-specific immunoglobulin G antibody concentrations for the 4vHPV types (HPV 6/11/16/18). RESULTS All participants (N = 469) had detectable antibodies against all 4vHPV types at all timepoints post-vaccination. For all 4vHPV types, antibody levels peaked by 1 month post-vaccination and gradually declined in subsequent years. At 5 years post-vaccination, antibody levels were higher among children who received 4vHPV at a younger age. CONCLUSIONS Alaska Native children maintained antibodies against all 4vHPV types at 5 years post-vaccination.
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MESH Headings
- Humans
- Child
- Adolescent
- Female
- Papillomavirus Infections/prevention & control
- Papillomavirus Infections/immunology
- Antibodies, Viral/blood
- Male
- Alaska Natives/statistics & numerical data
- Immunogenicity, Vaccine
- Alaska
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Vaccination
- Immunoglobulin G/blood
- Papillomavirus Vaccines/immunology
- Papillomavirus Vaccines/administration & dosage
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Affiliation(s)
- Bionca M Davis
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ian Blake
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gail Thompson
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Jesse Geis
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Dana Bruden
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Marc Fischer
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA.
| | - Rosalyn Singleton
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA; Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael G Bruce
- Arctic Investigations Program, Division of Infectious Disease Readiness and Innovation, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
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4
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Goldstone SE. Human papillomavirus (HPV) vaccines in adults: Learnings from long-term follow-up of quadrivalent HPV vaccine clinical trials. Hum Vaccin Immunother 2023; 19:2184760. [PMID: 36916016 PMCID: PMC10038021 DOI: 10.1080/21645515.2023.2184760] [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: 03/16/2023] Open
Abstract
The risk for acquiring human papillomavirus (HPV) infections and associated diseases is lifelong. An important part of prophylactic HPV vaccine development is durable protection against infection and disease. With comprehensive long-term follow-up (LTFU) in adolescents, men, and women, the quadrivalent HPV (qHPV) vaccine demonstrated durable effectiveness, immunogenicity, and safety, with almost no breakthrough disease. Those who received a placebo during initial trials were offered the qHPV vaccine at study conclusion and continued to be followed in LTFU extensions. In this catch-up vaccination group, LTFU demonstrated protection even in individuals with current or prior HPV infection after approximately 3 years. The initial efficacy and durable long-term effectiveness of the qHPV vaccine have already translated to a real-world reduction in cancer and cancer precursors. To date, there is no evidence of waning protection; evidence suggests that vaccination ultimately provides strong protection against future disease, with effective prophylaxis even among those with past infections.
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Affiliation(s)
- Stephen E Goldstone
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Restrepo J, Herrera T, Samakoses R, Reina JC, Pitisuttithum P, Ulied A, Bekker LG, Moreira ED, Olsson SE, Block SL, Hammes LS, Laginha F, Ferenczy A, Kurman R, Ronnett BM, Stoler M, Bautista O, Gallagher NE, Salituro G, Ye M, Luxembourg A. Ten-Year Follow-up of 9-Valent Human Papillomavirus Vaccine: Immunogenicity, Effectiveness, and Safety. Pediatrics 2023; 152:e2022060993. [PMID: 37667847 DOI: 10.1542/peds.2022-060993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The 9-valent human papillomavirus (9vHPV) vaccine Phase III immunogenicity study in 9- to 15-year-old boys and girls was extended to assess immunogenicity and effectiveness through 10 years after the last vaccine dose (NCT00943722). METHODS Boys (n = 301) and girls (n = 971) who received three 9vHPV vaccine doses in the base study (day 1, months 2 and 6) enrolled in the extension. Serum was collected through month 126 for antibody assessments by competitive Luminex immunoassay and immunoglobulin G-Luminex immunoassay. For effectiveness analysis starting at age 16 years, genital swabs were collected (to assess HPV DNA by polymerase chain reaction) and external genital examinations conducted every 6 months. Primary analyses were conducted in per-protocol populations. RESULTS Geometric mean antibody titers peaked around month 7, decreased sharply between months 7 and 12, then gradually through month 126. Seropositivity rates remained ≥81% by competitive Luminex immunoassay and ≥95% by immunoglobin G-Luminex immunoassay at month 126 for each 9vHPV vaccine type. After up to 11.0 (median 10.0) years of follow-up postdose 3, there were no cases of HPV6/11/16/18/31/33/45/52/58-related high-grade intraepithelial neoplasia or condyloma in males or females. Incidence rates of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection in males and females were low (54.6 and 52.4 per 10000 person-years, respectively) and within ranges expected in vaccinated cohorts, based on previous human papillomavirus vaccine efficacy trials. CONCLUSIONS The 9vHPV vaccine demonstrated sustained immunogenicity and effectiveness through ∼10 years post 3 doses of 9vHPV vaccination of boys and girls aged 9 to 15 years.
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Affiliation(s)
- Jaime Restrepo
- Foundation Clinical Research Center CIC, Medellín, Colombia
| | | | | | - Julio C Reina
- Department of Pediatrics, Universidad del Valle and Centro Médico Imbanaco, Cali, Colombia
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Angels Ulied
- Pediatrics Department, EBA Centelles, Centelles, Spain
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Ministry of Health, Salvador, BA, Brazil
| | | | - Stan L Block
- Kentucky Pediatric and Adult Research Inc, Bardstown, Kentucky
| | | | | | - Alex Ferenczy
- Department of Pathology, McGill University, Montreal, Quebec, Canada
| | - Robert Kurman
- Department of Gynecology and Obstetrics and Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Brigitte M Ronnett
- Department of Gynecology and Obstetrics and Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Mark Stoler
- Department of Pathology, University of Virginia, Charlottesville, Virginia
| | | | | | | | - Min Ye
- Merck and Co, Inc., Rahway, New Jersey
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6
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Autoimmunity in patients reporting long-term complications after exposure to human papilloma virus vaccination. J Autoimmun 2022; 133:102921. [PMID: 36356549 DOI: 10.1016/j.jaut.2022.102921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022]
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7
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Garland SM, Anagani M, Bhatla N, Chatterjee S, Lalwani S, Ross C, Group T, Lin J, Luxembourg A, Walia A, Tu Y. Immunogenicity and safety of quadrivalent and 9-valent human papillomavirus vaccines in Indian clinical trial participants. Hum Vaccin Immunother 2022; 18:2105067. [PMID: 35997582 DOI: 10.1080/21645515.2022.2105067] [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: 12/15/2022] Open
Abstract
The quadrivalent human papillomavirus (qHPV; HPV6/11/16/18) and 9-valent HPV (9vHPV; HPV6/11/16/18/31/33/45/52/58) vaccines have demonstrated efficacy, immunogenicity, and safety in international clinical trials. We report outcomes from three completed clinical trials in India: a single-arm study (V501-029 [NCT00380367]) in Indian girls (aged 9-15 years; N = 110) evaluating qHPV vaccine immunogenicity and safety; a subgroup analysis (n = 225) of Indian girls/boys (9-15 years) and women (16-26 years) from a global study (V503-002 [NCT00943722]) evaluating 9vHPV vaccine immunogenicity and safety; and a qHPV vaccine post-marketing safety surveillance study (V501-125) in Indian females (aged 9-45 years; N = 188) vaccinated during routine care. In V501-029 and V503-002, HPV vaccines were administered as 3 doses (Day 1, Month 2, Month 6). Serum HPV antibodies were evaluated by competitive Luminex immunoassays at Day 1 and Month 7 (both studies) and Months 12, 24, and 36 (V503-002 only). Adverse events (AEs) were collected by Vaccination Report Card. In V501-125, participants were actively surveilled for serious AEs (SAEs) within 30 days post-qHPV vaccination. In per-protocol analyses, qHPV and 9vHPV vaccines induced robust anti-HPV6/11/16/18 (V501-029) and HPV6/11/16/18/31/33/45/52/58 (V503-002) responses, respectively; ≥97% of participants seroconverted at Month 7 for each vaccine HPV type in both studies, and antibody responses persisted through 36 months in V503-002. The most common AEs were injection-site-associated. Most AEs were mild/moderate; no deaths, vaccine-related SAEs, or discontinuations due to AEs were reported. In V501-125, no SAE was reported. Overall, the qHPV and 9vHPV vaccines elicited robust antibody responses and were generally well tolerated in Indian participants.
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Affiliation(s)
- Suzanne M Garland
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Manjula Anagani
- Woman and Child Institute, CARE Super Specialty Hospital & Transplant Centre, Hyderabad, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sukanta Chatterjee
- Department of Pediatrics, KPC Medical College & Hospital, Kolkata, India
| | | | - Cecil Ross
- Department of Chest Medicine & Hematology, St. John's Medical College Hospital, Bangalore, India
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8
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Bhattacharjee R, Kumar L, Dhasmana A, Mitra T, Dey A, Malik S, Kim B, Gundamaraju R. Governing HPV-related carcinoma using vaccines: Bottlenecks and breakthroughs. Front Oncol 2022; 12:977933. [PMID: 36176419 PMCID: PMC9513379 DOI: 10.3389/fonc.2022.977933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Human papillomavirus (HPV) contributes to sexually transmitted infection, which is primarily associated with pre-cancerous and cancerous lesions in both men and women and is among the neglected cancerous infections in the world. At global level, two-, four-, and nine-valent pure L1 protein encompassed vaccines in targeting high-risk HPV strains using recombinant DNA technology are available. Therapeutic vaccines are produced by early and late oncoproteins that impart superior cell immunity to preventive vaccines that are under investigation. In the current review, we have not only discussed the clinical significance and importance of both preventive and therapeutic vaccines but also highlighted their dosage and mode of administration. This review is novel in its way and will pave the way for researchers to address the challenges posed by HPV-based vaccines at the present time.
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Affiliation(s)
- Rahul Bhattacharjee
- Department of Cell and Developmental Biology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lamha Kumar
- School of Biology, Indian Institute of Science Education and Research, Thiruvananthapuram, India
| | - Archna Dhasmana
- Himalayan School of Biosciences, Swami Rama Himalayan University, Dehradun, India
| | - Tamoghni Mitra
- KIIT School of Biotechnology, Kalinga Institute of Industrial Technology (KIIT-DU), Bhubaneswar, Odisha, India
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, West Bengal, India
| | - Sumira Malik
- Amity Institute of Biotechnology, Amity University Jharkhand, Ranchi, Jharkhand, India
| | - Bonglee Kim
- Department of Pathology, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
- *Correspondence: Bonglee Kim, ; Rohit Gundamaraju,
| | - Rohit Gundamaraju
- ER Stress and Mucosal Immunology Lab, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
- *Correspondence: Bonglee Kim, ; Rohit Gundamaraju,
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9
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Dundar Y, Eldem I, Schwartz C, Pomeroy L, Cordero J, Arslan O, Levent F. Screening Awareness of HPV-Related Oropharyngeal Cancers and Attitudes and Concerns towards HPV Vaccination Among Parents : HPV and Oropharyngeal Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1152-1160. [PMID: 33411252 DOI: 10.1007/s13187-020-01932-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Baseline population opinions on human papillomavirus (HPV) and HPV vaccination must be understood before physicians can address knowledge gaps in that population and encourage timely vaccination. To determine the opinions of parents of children age 9 to 18 on HPV-related oropharyngeal cancers (OPC); the associations with education level, socioeconomic status, and having a family member/friend with OPC; and the main concerns against having a vaccination., An anonymous survey was created and administered. Parents were asked to complete the survey if they met the inclusion criteria. After the survey, results were tabulated, and the answers for each question were analyzed. The target population was surveyed in the clinic. The target population was parents with children between 9 and 18 years old: the background knowledge and awareness of HPV-related OPC and associations with education level, socioeconomic status, having a family member/friend with OPC, and concerns about vaccination. Our study results showed that the age of parents, education level, marital status, personal vaccination status, and gender of the child are significant factors for background knowledge about HPV-related diseases. Similarly, the education level, the gender of the child, and personal vaccination status are significant factors towards attitudes against having children vaccinated. There is a strong correlation between background knowledge and attitudes. The main issues about vaccination are concerns about effectiveness and side effects, concerns about safe sex experiences, and the cost of vaccination. This is the first study designed to provide information on parents' knowledge of HPV-related cancers, prevalence of HPV vaccination, and attitudes and concerns about HPV vaccination in the USA. The lack of awareness of HPV-related cancers is a significant factor in attitudes against HPV vaccination.
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Affiliation(s)
- Yusuf Dundar
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8315, Lubbock, TX, 79430-8315, USA.
| | - Irem Eldem
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Cynthia Schwartz
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8315, Lubbock, TX, 79430-8315, USA
| | - Lisa Pomeroy
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Joehassin Cordero
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8315, Lubbock, TX, 79430-8315, USA
| | - Okan Arslan
- Department Educational Psychology and Leadership, Texas Tech University, Lubbock, TX, 79430, USA
| | - Fatma Levent
- Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
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10
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Maldonado I, Plata M, Gonzalez M, Correa A, Nossa C, Giuliano AR, Joura EA, Ferenczy A, Ronnett BM, Stoler MH, Jin Zhou H, Joshi A, Das R, Bautista O, Group T, Luxembourg A, Saah A, Buchwald UK. Effectiveness, immunogenicity, and safety of the quadrivalent HPV vaccine in women and men aged 27–45 years. Hum Vaccin Immunother 2022; 18:2078626. [PMID: 35853188 PMCID: PMC9481115 DOI: 10.1080/21645515.2022.2078626] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Among women aged 27–45 years, the quadrivalent human papillomavirus (qHPV; HPV6/11/16/18) vaccine was generally well tolerated, efficacious, and immunogenic in the placebo-controlled FUTURE III study (NCT00090220; n = 3253). The qHPV vaccine was also generally well tolerated and highly immunogenic in men aged 27–45 years who participated in the single-cohort mid-adult male (MAM) study (NCT01432574; n = 150). Here, we report results of a long-term follow up (LTFU) extension of FUTURE III with up to 10 years follow-up. To understand the relevance of the mid-adult women LTFU study in the context of mid-adult men vaccination, we report results from post-hoc, cross-study immunogenicity analyses conducted to compare immunogenicity (geometric mean titers; GMTs) at 1-month post-qHPV vaccine dose 3 in women and men aged 27–45 years versus women and men aged 16–26 years from prior efficacy studies. The qHPV vaccine demonstrated durable protection against the combined endpoint of HPV6/11/16/18-related high-grade cervical dysplasia and genital warts up to 10 years (median 8.9) post-dose 3 and sustained HPV6/11/16/18 antibody responses through approximately 10 years in women aged 27–45 years. Efficacy of qHPV vaccine in men aged 27–45 years was inferred based on the cross-study analysis of qHPV vaccine immunogenicity demonstrating non-inferior HPV6/11/16/18 antibody responses in men aged 27–45 years versus 16–26 years. In conclusion, durable effectiveness of the qHPV vaccine was demonstrated in women 27–45 years of age, and vaccine efficacy was inferred in men 27–45 years of age based on the serological results.
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Affiliation(s)
- Ivette Maldonado
- Department of Obstetrics & Gynaecology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Manuel Plata
- Department of Gynaecology, Fundación Cardioinfantil, Bogotá, Colombia
| | - Mauricio Gonzalez
- Ginecologo Oncologo, Instituto Nacional de Cancerología, Bogotá, Colombia
| | | | | | - Anna R. Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Elmar A. Joura
- Department of Obstetrics & Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Alex Ferenczy
- Department of Gynecologic Pathology and Cytopathology, University Health Center and Jewish General Hospital, Montreal, Quebec, Canada
| | - Brigitte M. Ronnett
- Johns Hopkins Gynecologic Pathology Consultation Service, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark H. Stoler
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
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11
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Tao Y, Shao H, Zhang T, Pu J, Tang C. Factors Influencing Men’s Attitudes toward HPV Vaccination in Males Included in the Chinese National Immunization Program. Vaccines (Basel) 2022; 10:vaccines10071054. [PMID: 35891217 PMCID: PMC9319647 DOI: 10.3390/vaccines10071054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Human papillomavirus (HPV) infection is the most common sexually transmitted disease, and it is associated with anogenital warts and oropharyngeal and anogenital cancers. Among female malignant tumors in China, the incidence of cervical cancer ranks second, with only breast cancer being more prevalent. HPV infection and related diseases affects both women and men. HPV vaccination is an optimal prevention strategy in preventing HPV infection and related diseases. The inclusion of the HPV vaccine in the national immunization program is an effective way to increase immunization coverage, reduce the burden of HPV related diseases, and increase national life expectancy. Objective: This study aimed to explore the factors influencing the attitudes of Chinese men toward the inclusion of the HPV vaccine in males included in the national immunization program, thus providing reference for launching the national immunization program policy. Methods: We invited men aged 20 to 45 to participate in an online survey. The participants were requested to complete a questionnaire, including sociodemographic characteristics, sexual behavior characteristics, knowledge of HPV and the HPV vaccine, and attitudes toward the HPV vaccine. A logistic regression model was constructed to analyze the influencing factors of attitudes. Results: A total of 660 males in China participated in this survey, and 80.45% supported the inclusion of HPV vaccines in national immunization programs. Participants earning CNY 100,000–200,000 (dds ratio (OR): 0.63, 95% confidence interval (CI): 0.39–1.00) or ≥200,000 (OR: 0.34, 95% CI: 0.17–0.68) were more likely to disapprove this strategy. Compared with people without a history of HPV infection, those with a history of HPV infection (OR: 1.84, 95% CI: 1.17–2.90) were more likely to approve. Men who had better knowledge of HPV were more likely to approve than men with less knowledge about HPV (OR: 1.44, 95% CI: 1.17–1.79). Compared with participants who did not know when the HPV vaccine should be given, those who knew that the ideal time of vaccination is before an individual becomes sexually active (OR: 1.75, 95% CI: 1.04–2.95) were more likely to approve. Conclusion: One in five men did not support the inclusion of HPV vaccines in national immunization programs, and they are likely to be from higher socioeconomic background and have poor knowledge of HPV. In order to implement comprehensive immunity, targeted actions need to be taken at national and public levels. In addition, when implementing measures, more attention needs to be paid to lower income men, men without a history of HPV infection and with poor knowledge of HPV, as well as young men.
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Affiliation(s)
- Yi Tao
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (Y.T.); (J.P.)
| | - Huarui Shao
- College of Pharmacy, Chongqing Medical University, Chongqing 400016, China;
| | - Ting Zhang
- The First Clinical College, Chongqing Medical University, Chongqing 400016, China;
| | - Junliang Pu
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (Y.T.); (J.P.)
| | - Chengyong Tang
- Department of Phase I Clinical Trial Ward, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (Y.T.); (J.P.)
- Correspondence: ; Tel.: +86-189-8328-6980
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12
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Velicer C, Luxembourg A, Chen YT, Kohn M, Saah A. Using observational data to explore the hypothesis that a single dose of current HPV vaccines can provide durable protection. Vaccine 2022; 40:3275-3277. [DOI: 10.1016/j.vaccine.2022.04.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
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13
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Lv H, Wang S, Liang Z, Yu W, Yan C, Chen Y, Hu X, Fu R, Zheng M, Group T, Luxembourg A, Liao X, Chen Z. Immunogenicity and safety of the 9-valent human papillomavirus vaccine in Chinese females 9-45 years of age: A phase 3 open-label study. Vaccine 2022; 40:3263-3271. [PMID: 35487814 DOI: 10.1016/j.vaccine.2022.02.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 9-valent human papillomavirus (9vHPV; HPV6/11/16/18/31/33/45/52/58) vaccine was approved for use in Chinese women aged 16-26 years in 2018. This phase 3, open-label study (NCT03903562) compared 9vHPV vaccine immunogenicity and safety in Chinese females aged 9-19 years and 27-45 years with Chinese females aged 20-26 years; we report results from day 1 through 1 month post-Dose 3. The study will continue through 54 months post-Dose 3 to assess antibody persistence in Chinese girls aged 9-19 years. METHODS Participants aged 9-45 years received three doses of the 9vHPV vaccine. Geometric mean titers (GMTs) and seroconversion percentages for anti-HPV6/11/16/18/31/33/45/52/58 antibodies were determined by competitive Luminex immunoassay in serum samples obtained at day 1 and 1 month post-Dose 3. Adverse events (AEs) within 30 days post-vaccination and serious AEs (SAEs) occurring at any time were recorded. RESULTS In total, 1990 participants (690 aged 9-19 years; 650 aged 20-26 years; 650 aged 27-45 years) were enrolled. At 1 month post-Dose 3, >99% of participants in the per-protocol immunogenicity population seroconverted to each vaccine HPV type. Anti-HPV6/11/16/18/31/33/45/52/58 antibody GMTs in the 9-19-year age group were non-inferior to those in participants aged 20-26 years. Anti-HPV6/11/16/18/31/33/45/52/58 seroconversion percentages in the 27-45-year age group were non-inferior to those in participants aged 20-26 years. Injection-site and systemic AEs were reported by 43.3% and 50.9%, 50.5% and 57.1%, and 43.8% and 43.4% of participants aged 9-19, 20-26, and 27-45 years, respectively. There were no vaccine-related SAEs, discontinuations due to AEs, and deaths. CONCLUSION Antibody responses induced by 9vHPV vaccination in Chinese females aged 9-19 years and 27-45 years were non-inferior to those in Chinese females aged 20-26 years. The vaccine was generally well tolerated. CLINICALTRIALS gov Identifier: NCT03903562.
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Affiliation(s)
- Huakun Lv
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China.
| | - Shenyu Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China.
| | - Zhenzhen Liang
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China.
| | - Wei Yu
- Keqiao District Center for Disease Control and Prevention, Zhejiang, China.
| | - Chuanfu Yan
- Kaihua County Center for Disease Control and Prevention, Zhejiang, China.
| | - Yingping Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China.
| | - Xiaosong Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China.
| | - Rong Fu
- MSD R&D (China) Co., Ltd., Beijing, China.
| | | | | | | | | | - Zhiping Chen
- Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China.
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Kurosawa M, Sekine M, Yamaguchi M, Kudo R, Hanley SJB, Hara M, Adachi S, Ueda Y, Miyagi E, Ikeda S, Yagi A, Enomoto T. Long-Term Effects of Human Papillomavirus Vaccination in Clinical Trials and Real-World Data: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10020256. [PMID: 35214713 PMCID: PMC8877934 DOI: 10.3390/vaccines10020256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/04/2022] Open
Abstract
The preventive effect of HPV vaccines against anogenital and oropharyngeal cancers has been proven in both clinical trials and real-world data. We reviewed the published evidence about the long-term efficacy and effectiveness of the HPV vaccine in available papers of clinical trials and real-world data. As far as we searched, the longest period of preventive effect for the bivalent, 4-valent, and 9-valent vaccine were 11 years in the Costa Rica trial, 14 years in the FUTURE II, and 8 years in the LTFU extension study of V503-002 and the Scandinavian study, respectively. The sustained clinical effect during the observation period was longest for the 4-valent vaccine. In real-world data, the longest observation period of the vaccine effectiveness was 12 years in an Australian study for the 4-valent vaccine. On the other hand, the longest period of long-term persistence of HPV vaccine-induced seropositivity was 14 years in FUTURE II for the 4-valent vaccine. For the bivalent vaccine, additional long-term follow-up studies may not have been planned due to the launch of the 4-valent and 9-valent vaccines. In some studies of the 9-valent vaccine, the results have not yet been published because of the short observation period. The additional results are expected in the future. In a national immunization program, most girls and boys are inoculated with HPV vaccine by the time puberty begins; thus, it is important to monitor the vaccine effect at least until the sexually active period in their 20s and 30s.
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Affiliation(s)
- Megumi Kurosawa
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan; (M.K.); (M.Y.); (R.K.); (S.A.); (T.E.)
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan; (M.K.); (M.Y.); (R.K.); (S.A.); (T.E.)
- Correspondence:
| | - Manako Yamaguchi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan; (M.K.); (M.Y.); (R.K.); (S.A.); (T.E.)
| | - Risa Kudo
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan; (M.K.); (M.Y.); (R.K.); (S.A.); (T.E.)
| | - Sharon J. B. Hanley
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo 060-8638, Japan;
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga 849-8501, Japan;
| | - Sosuke Adachi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan; (M.K.); (M.Y.); (R.K.); (S.A.); (T.E.)
| | - Yutaka Ueda
- Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Y.U.); (A.Y.)
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama 236-0004, Japan;
| | - Sayaka Ikeda
- Division of Surveillance and Policy Evaluation, Institute for Cancer Control, National Cancer Center, Tokyo 104-0045, Japan;
| | - Asami Yagi
- Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan; (Y.U.); (A.Y.)
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan; (M.K.); (M.Y.); (R.K.); (S.A.); (T.E.)
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15
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Goldstone SE, Giuliano AR, Palefsky JM, Lazcano-Ponce E, Penny ME, Cabello RE, Moreira ED, Baraldi E, Jessen H, Ferenczy A, Kurman R, Ronnett BM, Stoler MH, Bautista O, Das R, Group T, Luxembourg A, Zhou HJ, Saah A. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 trial. THE LANCET. INFECTIOUS DISEASES 2021; 22:413-425. [PMID: 34780705 DOI: 10.1016/s1473-3099(21)00327-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The quadrivalent human papillomavirus (HPV) vaccine was shown to prevent infections and lesions related to HPV6, 11, 16, and 18 in a randomised, placebo-controlled study in men aged 16-26 years. We assessed the incidences of external genital warts related to HPV6 or 11, and external genital lesions and anal dysplasia related to HPV6, 11, 16, or 18, over 10 years of follow-up. METHODS The 3-year base study was an international, multicentre, double-blind, randomised, placebo-controlled trial done at 71 sites in 18 countries. Eligible participants were heterosexual men (aged 16-23 years) or men who have sex with men (MSM; aged 16-26 years). Men who had clinically detectable anogenital warts or genital lesions at screening that were suggestive of infection with non-HPV sexually transmitted diseases, or who had a history of such findings, were excluded. Eligible participants were randomly assigned (1:1) to receive three doses of either quadrivalent HPV vaccine or placebo on day 1, month 2, and month 6, administered as a 0·5-mL injection into the deltoid muscle. The 7-year, open-label, long-term follow-up extension study was done at 46 centres in 16 countries. Participants who received one or more doses of the quadrivalent HPV vaccine in the base study were eligible for enrolment into the long-term follow-up study (early vaccination group). Placebo recipients were offered the three-dose quadrivalent HPV vaccine at the end of the base study; those who received one or more quadrivalent HPV vaccine doses were eligible for enrolment into the long-term follow-up study (catch-up vaccination group). The primary efficacy endpoints were the incidence of external genital warts related to HPV6 or 11 and the incidence of external genital lesions related to HPV6, 11, 16, or 18 in all participants and the incidence of anal intraepithelial neoplasia (including anal warts and flat lesions) or anal cancer related to HPV6, 11, 16, or 18 in MSM only. The primary efficacy analysis was done in the per-protocol population for the early vaccination group, which included participants who received all three vaccine doses, were seronegative at day 1 and PCR-negative from day 1 through month 7 of the base study for the HPV type being analysed, had no protocol violations that could affect evaluation of vaccine efficacy, and had attended at least one visit during the long-term follow-up study. For the catch-up vaccination group, efficacy was assessed in the modified intention-to-treat population, which included participants who had received at least one vaccine dose, were seronegative and PCR-negative for HPV types analysed from day 1 of the base study to the final follow-up visit before receiving the quadrivalent HPV vaccine, and had at least one long-term follow-up visit. Safety was assessed in all randomised participants who received at least one vaccine dose. This study is registered with ClinicalTrials.gov, NCT00090285. FINDINGS Between Aug 10, 2010, and April 3, 2017, 1803 participants were enrolled in the long-term follow-up study, of whom 936 (827 heterosexual men and 109 MSM) were included in the early vaccination group and 867 (739 heterosexual men and 128 MSM) were included in the catch-up vaccination group. Participants in the early vaccination group were followed up for a median of 9·5 years (range 0·1-11·5) after receiving the third dose of the quadrivalent HPV vaccine, and participants in the catch-up vaccination group were followed up for a median of 4·7 years (0·0-6·6) after receiving the third dose. In early vaccine group participants during long-term follow-up compared with the placebo group in the base study, the incidence per 10 000 person-years of external genital warts related to HPV6 or 11 was 0·0 (95% CI 0·0-8·7) versus 137·3 (83·9-212·1), of external genital lesions related to HPV6, 11, 16, or 18 was 0·0 (0·0-7·7) versus 140·4 (89·0-210·7), and of anal intraepithelial neoplasia or anal cancer related to HPV6, 11, 16, or 18 in MSM only was 20·5 (0·5-114·4) versus 906·2 (553·5-1399·5). Compared with during the base study (ie, before quadrivalent HPV vaccine administration), during the long-term follow-up period, participants in the catch-up vaccination group had no new reported cases of external genital warts related to HPV6 or 11 (149·6 cases per 10 000 person-years [95% CI 101·6-212·3] vs 0 cases per 10 000 person-years [0·0-13·5]) or external genital lesions related to HPV6, 11, 16, or 18 (155·1 cases per 10 000 person-years [108·0-215·7] vs 0 cases per 10 000 person-years [0·0-10·2]), and a lower incidence of anal intraepithelial neoplasia or anal cancer related to HPV6, 11, 16, or 18 (886·0 cases per 10 000 person-years [583·9-1289·1] vs 101·3 cases per 10 000 person-years [32·9-236·3]). No vaccine-related serious adverse events were reported. INTERPRETATION The quadrivalent HPV vaccine provides durable protection against anogenital disease related to HPV6, 11, 16, and 18. The results support quadrivalent HPV vaccination in men, including catch-up vaccination. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Joel M Palefsky
- Department of Medicine, University of California at San Francisco, CA, USA
| | | | - Mary E Penny
- Instituto de Investigación Nutricional, Lima, Peru
| | | | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Ezio Baraldi
- Trialtech Research Institute, Pretoria, South Africa
| | | | - Alex Ferenczy
- McGill University Health Center, Montreal, QC, Canada
| | - Robert Kurman
- Department of Gynecology and Obstetrics and Department of Pathology Johns Hopkins University, Baltimore, MD, USA
| | - Brigitte M Ronnett
- Department of Gynecology and Obstetrics and Department of Pathology Johns Hopkins University, Baltimore, MD, USA
| | - Mark H Stoler
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | - Hao Jin Zhou
- MSD China, Beijing, China; Sun Yat-sen University, Guangzhou, China
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Cho HW, Min KJ, Kwon SH, Kim K, Kim S, Seong SJ, Song YJ, Lee KH, Lee SW, Lee JW, Ju W, Kim YT, Lee JK. Updated clinical guideline for human papillomavirus vaccine: the Korean Society of Gynecologic Oncology guidelines. J Gynecol Oncol 2021; 32:e94. [PMID: 34708596 PMCID: PMC8550930 DOI: 10.3802/jgo.2021.32.e94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
Since the human papillomavirus (HPV) vaccine guidelines were developed by the Korean Society of Gynecologic Oncology (KSGO) in 2011, 2016, and 2019, several recent studies on the efficacy and safety of HPV vaccines in middle-aged women and men have been reported. Furthermore, there has been an ongoing debate regarding the efficacy of the HPV vaccine in women with prior HPV infection or who have undergone conization for cervical intraepithelial neoplasia (CIN). We searched and reviewed studies on the efficacy and safety of the HPV vaccine in middle-aged women and men and the efficacy of the HPV vaccine in patients infected with HPV and those who underwent conization for CIN. The KSGO updated their guidelines based on the results of the studies included in this review.
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Affiliation(s)
- Hyun-Woong Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang-Hoon Kwon
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woong Ju
- Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
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Hoes J, Pasmans H, Schurink-van 't Klooster TM, van der Klis FRM, Donken R, Berkhof J, de Melker HE. Review of long-term immunogenicity following HPV vaccination: Gaps in current knowledge. Hum Vaccin Immunother 2021; 18:1908059. [PMID: 34033518 PMCID: PMC8920133 DOI: 10.1080/21645515.2021.1908059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The licensed HPV vaccines are highly efficacious and induce high levels of neutralizing antibody levels, the assumed mediators of protection. However, a correlate of protection against HPV is lacking, and the evidence is still limited as to long-term persistence of antibodies, especially following reduced dosing schedules. The World Health Organization (WHO) urges immunization of young girls as part of the strategy to eliminate cervical cancer, thus long-lasting protection is required. The current review describes long-term follow-up regarding vaccine-induced seropositivity and antibody level development following the different vaccines and dosing schedules. Implications and opportunities of long-term vaccine-induced immune responses are discussed, such as the gaps in monitoring of long-term immunogenicity, the possibilities of reduced dosing schedules, and the importance of evidence for durable immunity.
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Affiliation(s)
- J Hoes
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H Pasmans
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T M Schurink-van 't Klooster
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - F R M van der Klis
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - R Donken
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Berkhof
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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18
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Dang JHT, Stewart SL, Blumberg DA, Rodriguez HP, Chen MS. Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network. Vaccine 2021; 39:3528-3535. [PMID: 34023133 DOI: 10.1016/j.vaccine.2021.04.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11-17, of a large community-based primary care network. METHODS Electronic health records and administrative data from a large primary care network from January 2017 - June 2018 for patients ages 11-17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake. RESULTS Most patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1-3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6-2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 - 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3-0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7-0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 - 1.0). CONCLUSION HPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.
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Affiliation(s)
- Julie H T Dang
- University of California, Davis School of Medicine, Division of Health Policy and Management, Department of Public Health Sciences, 4501 X Street, Suite 3003, Sacramento, CA 95817, USA.
| | - Susan L Stewart
- University of California, Davis School of Medicine, Division of Biostatistics, Department of Public Health Sciences, 2450 48th Street, Suite 1600, Sacramento, CA 95817, USA
| | - Dean A Blumberg
- University of California, Davis Health, Department of Pediatrics, 2561 Stockton Blvd, Sacramento, CA 95817, USA
| | - Hector P Rodriguez
- University of California, Berkeley, School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way #5427, Berkeley, CA 94704, USA
| | - Moon S Chen
- University of California, Davis School of Medicine, Division of Hematology and Oncology, 2540 48th Street, Suite 1600, Sacramento, CA 95817, USA
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19
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Zimet GD, Silverman RD, Bednarczyk RA, English A. Adolescent Consent for Human Papillomavirus Vaccine: Ethical, Legal, and Practical Considerations. J Pediatr 2021; 231:24-30. [PMID: 33484694 PMCID: PMC8005441 DOI: 10.1016/j.jpeds.2021.01.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
We address ethical, legal, and practical issues related to adolescent self-consent for human papillomavirus (HPV) vaccination. HPV vaccination coverage continues to lag well behind the national goal of 80% series completion. Structural and behavioral interventions have improved vaccination rates, but attitudinal, behavioral, and access barriers remain. A potential approach for increasing access and improving vaccination coverage would be to permit adolescents to consent to HPV vaccination for themselves. We argue that adolescent self-consent is ethical, but that there are legal hurdles to be overcome in many states. In jurisdictions where self-consent is legal, there can still be barriers due to lack of awareness of the policy among healthcare providers and adolescents. Other barriers to implementation of self-consent include resistance from antivaccine and parent rights activists, reluctance of providers to agree to vaccinate even when self-consent is legally supported, and threats to confidentiality. Confidentiality can be undermined when an adolescent's self-consented HPV vaccination appears in an explanation of benefits communication sent to a parent or if a parent accesses an adolescent's vaccination record via state immunization information systems. In the context of the COVID-19 pandemic, which has led to a substantial drop in HPV vaccination, there may be even more reason to consider self-consent. The atmosphere of uncertainty and distrust surrounding future COVID-19 vaccines underscores the need for any vaccine policy change to be pursued with clear communication and consistent with ethical principles.
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Affiliation(s)
- Gregory D. Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN,Reprint requests: Gregory D. Zimet, PhD, Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, 410 W 10th Street, HS 1001, Indianapolis, IN 46202
| | - Ross D. Silverman
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health and Robert H. McKinney School of Law, Indianapolis, IN
| | - Robert A. Bednarczyk
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Cancer Prevention and Control Program, Winship Cancer Institute, Emory University, and Emory Vaccine Center, Emory University, Atlanta, GA
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Phua LC, Choi HCW, Wu J, Jit M, Low J, Ng K, Pearce F, Hall C, Abdul Aziz MI. Cost-effectiveness analysis of the nonavalent human papillomavirus vaccine for the prevention of cervical cancer in Singapore. Vaccine 2021; 39:2255-2263. [PMID: 33744050 DOI: 10.1016/j.vaccine.2021.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The nonavalent human papillomavirus (HPV) vaccine has been shown to extend protection against oncogenic HPV types 31/33/45/52/58 (HPV-OV) not covered by the bivalent and quadrivalent HPV vaccines. Besides its clinical benefit, evidence on the economic value of the nonavalent vaccine is required to inform local vaccination strategies and funding decisions. This study evaluated the cost-effectiveness of replacing the bivalent vaccine with the nonavalent vaccine in the national school-based HPV vaccination programme in Singapore. METHODS An existing age-structured dynamic transmission model coupled with stochastic individual-based simulations was adapted to project the health and economic impact of vaccinating 13-year-old girls with two doses of the nonavalent or bivalent HPV vaccines in Singapore. Direct costs (in Singapore dollars, S$) were obtained from public healthcare institutions in Singapore, while health state utilities were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated over a lifetime horizon, from a healthcare system perspective. Probabilistic sensitivity analysis was performed to obtain the ICERs and corresponding variations across variable uncertainty. Particularly, this study tested the scenarios of lifelong and 20-year vaccine-induced protection, assumed 96.0% and 22.3% cross-protection against HPV-OV by nonavalent and bivalent vaccines respectively, and fixed vaccine prices per dose at S$188 for nonavalent and S$61.50 for bivalent vaccines. RESULTS Compared with the bivalent vaccine, the use of the nonavalent vaccine was associated with an ICER of S$61,629 per quality-adjusted life year gained in the base case. The result was robust across a range of plausible input values, and to assumptions regarding the duration of vaccine protection. CONCLUSION Given the high ICER, the nonavalent vaccine is unlikely to represent a cost-effective option compared with the bivalent vaccine for school-based HPV vaccination of 13-year old female students in Singapore. Substantial price reductions would be required to justify its inclusion in the school-based programme in the future.
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Affiliation(s)
- Lee Cheng Phua
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Horace C W Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Joseph Wu
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region; WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jeffrey Low
- Gynaecologic Oncology, National University Cancer Institute, National University Hospital, Singapore
| | - Kwong Ng
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Fiona Pearce
- Agency for Care Effectiveness, Ministry of Health, Singapore
| | - Cameron Hall
- Agency for Care Effectiveness, Ministry of Health, Singapore
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Immunogenicity and safety of a nine-valent human papillomavirus vaccine in women 27-45 years of age compared to women 16-26 years of age: An open-label phase 3 study. Vaccine 2021; 39:2800-2809. [PMID: 33676783 DOI: 10.1016/j.vaccine.2021.01.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Efficacy of the nine-valent human papillomavirus (9vHPV; HPV types 6/11/16/18/31/33/45/52/58) vaccine was demonstrated in a phase 3 study in women 16-26 years of age. We present a phase 3 immunogenicity and safety study of the 9vHPV vaccine in women 27-45 versus 16-26 years of age. METHODS This international, open-label study (NCT03158220) was conducted in women 16-45 years of age. Participants (16-26 years, n = 570 and 27-45 years, n = 642) received a three-dose 9vHPV vaccination regimen (day 1, month 2, month 6). Month 7 geometric mean titers (GMTs) and seroconversion percentages to anti-HPV 6/11/16/18/31/33/45/52/58 were assessed. Participants were followed for safety throughout the study. RESULTS At month 7, anti-HPV 6/11/16/18/31/33/45/52/58 GMTs in women 27-45 years were compared to those in women 16-26 years of age. The primary hypothesis of non-inferiority of anti-HPV 16/18/31/33/45/52/58 GMTs in older versus younger women was met. The lower bound of the GMT ratio 95% confidence interval (27-45 years to 16-26 years) was 0.60-0.67 depending on HPV type, exceeding the non-inferiority margin of 0.5 for all HPV types. Month 7 seroconversion percentages in women 27-45 years of age were >99% for all HPV types. Injection-site and vaccine-related systemic adverse events (AEs) were observed in 87.5% and 25.1% of women 16-26 years, and 85.2% and 24.1% of women 27-45 years of age, respectively; no vaccine-related serious AEs were reported and no deaths occurred during the study. CONCLUSIONS The 9vHPV vaccine elicited non-inferior anti-HPV GMTs in women 27-45 years compared with women 16-26 years of age for HPV 16/18/31/33/45/52/58. The vaccine was generally well tolerated with a similar AE profile across the age groups. These data support bridging 9vHPV vaccine efficacy findings in women 16-26 years to women 27-45 years of age. Clinical trial registration NCT03158220.
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Kuter BJ, Garland SM, Giuliano AR, Stanley MA. Current and future vaccine clinical research with the licensed 2-, 4-, and 9-valent VLP HPV vaccines: What's ongoing, what's needed? Prev Med 2021; 144:106321. [PMID: 33678229 DOI: 10.1016/j.ypmed.2020.106321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 01/28/2023]
Abstract
Prophylactic HPV vaccination has been a great public health success. For >20 years, clinical trials were conducted with the 2-, 4-, and/or 9-valent vaccines in young-adult females, mid-adult women, males, and adolescents. In all studies, the vaccines were highly efficacious, immunogenic, and well tolerated. Following vaccine licensure and utilization in national vaccine programs globally (real-world settings primarily in high income countries), numerous studies demonstrated that the vaccines continue to have an excellent safety profile and have dramatically reduced the incidence of genital warts, HPV vaccine-type prevalence, and precancerous lesions. Thirty-eight clinical trials with the currently licensed HPV vaccines are ongoing. Key questions being addressed in new trials include: efficacy against persistent infection and immunogenicity of a 1-dose regimen; efficacy of 3 doses in 20-45-year-old females; use in postpartum women and immunocompromised individuals (HIV, liver and kidney transplants); dose sparing via intradermal administration; use in combination with a PD1 monoclonal antibody in patients with cervical cancer; impact on recurrent disease in women undergoing cervical conization; persistence of protection; and use to prevent oropharyngeal cancer. Additional clinical research that should be conducted includes: long-term follow-up, particularly of 1- and 2-dose regimens; further evaluation of flexible 2-dose regimens; immunogenicity of 1- or 2-dose regimens in persons ≥15 years old and immunocompromised populations; safety and immunogenicity of 1 or 2 doses in children <9 years old; assessment of the vaccine in the prevention of transmission; interchangeability with newer HPV vaccines; additional concomitant use studies; and prevention of penile cancer and recurrent respiratory papillomatosis.
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Affiliation(s)
- Barbara J Kuter
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
| | - Suzanne M Garland
- The University of Melbourne, The Royal Women's Hospital, and Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, United States of America
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Wieland U, Kreuter A. [Prevention of HPV-induced diseases by prophylactic vaccination]. DER HAUTARZT 2020; 72:106-113. [PMID: 33337514 DOI: 10.1007/s00105-020-04739-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
Human papillomavirus (HPV) infections belong to the most frequent viral infections. Besides benign common warts and benign and malignant lesions of the head and neck area, HPV can induce anogenital dysplasias and cancers. Since the year 2007, effective and safe prophylactic HPV vaccines are licensed in Europe. To date, a bivalent (HPV16 and 18) and a nonavalent HPV vaccine (HPV6, 11, 16, 18, 31, 33, 45, 52, and 58) are commercially available in Germany. The German standing committee on vaccination (STIKO) currently recommends gender-neutral prophylactic HPV-vaccination between 9 and 14 years of age, with the possibility of catch-up vaccination until the age of 17 years. Besides a large proportion of HPV-induced anogenital dysplasias and carcinomas, the nonavalent HPV vaccine also prevents anogenital warts. Iatrogenically immunocompromised patients older than 17 years of age should also receive prophylactic HPV vaccination, preferrably by the age of 26 years. In case of already acquired HPV infection or existing HPV-induced lesions prophylactic vaccination does not lead to accelerated HPV elimination or clearance of lesions.
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Affiliation(s)
- Ulrike Wieland
- Institut für Virologie, Nationales Referenzzentrum für Papillom- und Polyomaviren, Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Josefstr. 3, 46045, Oberhausen, Deutschland.
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Olsson SE, Restrepo JA, Reina JC, Pitisuttithum P, Ulied A, Varman M, Van Damme P, Moreira ED, Ferris D, Block S, Bautista O, Gallagher N, McCauley J, Luxembourg A. Long-term immunogenicity, effectiveness, and safety of nine-valent human papillomavirus vaccine in girls and boys 9 to 15 years of age: Interim analysis after 8 years of follow-up. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2020; 10:100203. [PMID: 32659510 PMCID: PMC7396911 DOI: 10.1016/j.pvr.2020.100203] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The nine-valent human papillomavirus (9vHPV) vaccine protects against infection and disease related to HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. The pivotal 36-month Phase III immunogenicity study of 9vHPV vaccine in 9- to 15-year-old girls and boys was extended to assess long-term immunogenicity and effectiveness through approximately 10 years after vaccination. We describe results of an interim analysis based on approximately 8 years of follow-up after vaccination. METHODS Participants aged 9-15 years who received three doses of 9vHPV vaccine (at day 1, month 2, and month 6) in the base study and consented to follow-up were enrolled in the long-term follow-up study extension (N = 1272 [females, n = 971; males, n = 301]). Serum was collected at months 66 and 90 to assess antibody responses. For effectiveness analysis, genital swabs were collected (to assess HPV DNA by polymerase chain reaction [PCR]) and external genital examination was conducted (to detect external genital lesions) every 6 months starting when the participant reached 16 years of age. Cervical cytology tests were conducted annually when female participants reached 21 years of age; participants with cytological abnormalities were triaged to colposcopy based on a protocol-specified algorithm. External genital and cervical biopsies of abnormal lesions were performed, and histological diagnoses were adjudicated by a pathology panel. Specimens were tested by PCR to detect HPV DNA. RESULTS Geometric mean titers for each 9vHPV vaccine HPV type peaked around month 7 and gradually decreased through month 90. Seropositivity rates remained >90% through month 90 for each of the 9vHPV vaccine types by HPV immunoglobulin Luminex Immunoassay. No cases of HPV6/11/16/18/31/33/45/52/58-related high-grade intraepithelial neoplasia or genital warts were observed in the per-protocol population (n = 1107) based on a maximum follow-up of 8.2 years (median 7.6 years) post-Dose 3. Incidence rates of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection in females and males were 49.2 and 37.3 per 10,000 person-years, respectively, which were within ranges expected in vaccinated cohorts. There were no vaccine-related SAEs or deaths during the period covered by this interim analysis. CONCLUSIONS The 9vHPV vaccine provided sustained immunogenicity and durable effectiveness through approximately 7 and 8 years, respectively, following vaccination of girls and boys aged 9-15 years.
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Affiliation(s)
| | | | - Julio Cesar Reina
- Department of Pediatrics, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Angels Ulied
- Pediatrics Department, EBA Centelles, Centelles, Spain
| | - Meera Varman
- Pediatric Infectious Diseases, Creighton University, Omaha, NE, USA
| | - Pierre Van Damme
- University of Antwerp, Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, Antwerp, Belgium
| | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil
| | - Daron Ferris
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia, USA
| | - Stanley Block
- Kentucky Pediatric and Adult Research Inc, Bardstown, KY, USA
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Huang Z, He J, Su J, Ou Z, Liu G, Fu R, Shou Q, Zheng M, Group T, Luxembourg A, Liao X, Zhang J. Immunogenicity and safety of the quadrivalent human papillomavirus vaccine in Chinese females aged 9 to 26 years: A phase 3, open-label, immunobridging study. Vaccine 2020; 39:760-766. [PMID: 33239228 DOI: 10.1016/j.vaccine.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The quadrivalent human papillomavirus (qHPV; HPV6/11/16/18) vaccine was approved for use in Chinese women aged 20-45 years in 2017. This Phase 3, open-label study (NCT03493542) aimed to assess immunogenicity and safety of the qHPV vaccine in Chinese girls aged 9-19 years versus Chinese young women aged 20-26 years; we report results from Day 1 through Month 7. The study will continue through Month 60 to assess antibody persistence in Chinese girls aged 9-19 years. METHODS Participants aged 9-26 years received three doses of the qHPV vaccine (Day 1, Month 2, Month 6). Geometric mean titers (GMTs) and seroconversion percentages for anti-HPV6/11/16/18 antibodies were determined by competitive Luminex immunoassay (cLIA) in serum samples obtained on Day 1 and at Month 7. Injection-site adverse events (AEs) and systemic AEs within 30 days post-vaccination, and serious AEs (SAEs) occurring at any time during the study, were recorded. RESULTS In total, 766 participants (383 aged 9-19 years; 383 aged 20-26 years) were enrolled and received ≥1 vaccine dose. All participants in the per-protocol immunogenicity population of both age groups seroconverted to each of the vaccine HPV types at Month 7. Anti-HPV6/11/16/18 antibody GMTs at Month 7 in participants aged 9-19 years were non-inferior to those in participants aged 20-26 years. Injection-site AEs and systemic AEs were reported by 36.6% and 49.3% of 9-19-year-olds, and 40.7% and 54.8% of 20-26-year-olds, respectively. There were no vaccine-related SAEs. No participants discontinued the vaccine due to an AE and no deaths were reported. CONCLUSION Antibody responses induced by the 3-dose qHPV vaccination regimen in Chinese girls aged 9-19 years were non-inferior to those in Chinese young women aged 20-26 years. The vaccine was generally well tolerated in the study population. ClinicalTrials.gov Identifier: NCT03493542.
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Affiliation(s)
- Zhuhang Huang
- Guangdong Provincial Institute of Biological Products and Materia Medica, 200 Xipengling Road, Guangzhou, Guangdong Province 510440, PR China
| | - Jianfeng He
- Guangdong Provincial Center for Disease Control and Prevention, 160 Qunxian Road, Guangzhou, Guangdong Province 511430, PR China
| | - Jiali Su
- Guangdong Provincial Institute of Biological Products and Materia Medica, 200 Xipengling Road, Guangzhou, Guangdong Province 510440, PR China
| | - Zhiqiang Ou
- Guangdong Provincial Institute of Biological Products and Materia Medica, 200 Xipengling Road, Guangzhou, Guangdong Province 510440, PR China
| | - Guixiu Liu
- MSD R&D (China) Co., Ltd., 21 Rong Da Road, Beijing 100012, PR China.
| | - Rong Fu
- MSD R&D (China) Co., Ltd., 21 Rong Da Road, Beijing 100012, PR China.
| | - Qiong Shou
- MSD R&D (China) Co., Ltd., 21 Rong Da Road, Beijing 100012, PR China.
| | - Minghuan Zheng
- MSD R&D (China) Co., Ltd., 21 Rong Da Road, Beijing 100012, PR China.
| | - Thomas Group
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Alain Luxembourg
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| | - Xueyan Liao
- MSD R&D (China) Co., Ltd., 21 Rong Da Road, Beijing 100012, PR China.
| | - Jikai Zhang
- Guangdong Provincial Institute of Biological Products and Materia Medica, 200 Xipengling Road, Guangzhou, Guangdong Province 510440, PR China.
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Chang WH. A review of vaccine effects on women in light of the COVID-19 pandemic. Taiwan J Obstet Gynecol 2020; 59:812-820. [PMID: 33218394 PMCID: PMC7486065 DOI: 10.1016/j.tjog.2020.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
The pandemic situation triggered by the spread of COVID-19 has caused great harm worldwide. More than six million people have been infected, and more than 360,000 of them have died. This is the worst catastrophe suffered by mankind in recent history. In the face of this severe disaster, people all over the world are frightened of the prospect of facing an outbreak or an annual recurrence. However, the development of a vaccine will help control the impact of COVID-19. Women in particular have been more seriously affected by the pandemic. Since the pressure and physical load they suffer are often greater than what men endure, women are more threatened by COVID-19. Though women have a poorer quality of life and work and face worse economic conditions, they also tend to have better physiological immunity than men, which can ease the effect of COVID-19. The early development of a vaccine against COVID-19 is an important issue that must take into consideration women's better immune response to the virus along with the technique of hormone regulation. Relevant research has been conducted on female-specific vaccines in the past, and women's issues were considered during those clinical trials to ensure that complications and antibody responses were positive and effective in women. National policies should also propose good strategies for women to be vaccinated. This could improve consciousness, give women a better vaccination experience, enhance their willingness to vaccinate, and protect them from COVID-19 infection.
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Affiliation(s)
- Wen-Han Chang
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Kyrgiou M, Arbyn M, Bergeron C, Bosch FX, Dillner J, Jit M, Kim J, Poljak M, Nieminen P, Sasieni P, Kesic V, Cuzick J, Gultekin M. Cervical screening: ESGO-EFC position paper of the European Society of Gynaecologic Oncology (ESGO) and the European Federation of Colposcopy (EFC). Br J Cancer 2020; 123:510-517. [PMID: 32507855 PMCID: PMC7434873 DOI: 10.1038/s41416-020-0920-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/21/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022] Open
Abstract
This paper summarises the position of ESGO and EFC on cervical screening based on existing guidelines and opinions of a team of lead experts. HPV test is replacing cytology as this offers greater protection against cervical cancer and allows longer screening intervals. Only a dozen of HPV tests are considered as clinically validated for screening. The lower specificity of HPV test dictates the use of triage tests that can select women for colposcopy. Reflex cytology is currently the only well validated triage test; HPV genotyping and p16 immunostaining may be used in the future, although methylation assays and viral load also look promising. A summary of quality assurance benchmarks is provided, and the importance to audit the screening histories of women who developed cancer is noted as a key objective. HPV-based screening is more cost-effective than cytology or cotesting. HPV-based screening should continue in the post-vaccination era. Only a fraction of the female population is vaccinated, and this varies across countries. A major challenge will be to personalise screening frequency according to vaccination status. Still the most important factor for successful prevention by screening is high population coverage and organised screening. Screening with self-sampling to reach under-screened women is promising.
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Affiliation(s)
- Maria Kyrgiou
- Department of Surgery and Cancer - Gut, Metabolism and Reproduction IRDB, Faculty of Medicine, Imperial College London, London, W12 0NN, UK.
- West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, W12 0HS, UK.
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - Christine Bergeron
- Department of Pathology, Laboratoire Cerba, 95066, Cergy Pontoise, Cedex 9, France
| | - F Xavier Bosch
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Universitat Oberta de Catalunya, Barcelona, Spain
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institut, Stockholm, Sweden
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Modelling and Economics Unit, National Infections Service, Public Health England, London, NW9 5EQ, UK
- School of Public Health, University of Hong Kong, Hong Kong, SAR, China
| | - Jane Kim
- Harvard T.H. Chan School of Public Health, Center for Health Decision Science, 718 Huntington Avenue, Boston, MA, 02115, USA
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Peter Sasieni
- King's Clinical Trials Unit, King's University, London, UK
| | - Vesna Kesic
- Medical Faculty, University of Belgrade; Clinic of Obstetrics and Gynecology, Clinical center of Serbia, Beograd, Serbia
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine - Barts and The London, Queen's Mary University, Charterhouse Square, EC1M 6BQ, London, UK
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Cheng L, Wang Y, Du J. Human Papillomavirus Vaccines: An Updated Review. Vaccines (Basel) 2020; 8:vaccines8030391. [PMID: 32708759 PMCID: PMC7565290 DOI: 10.3390/vaccines8030391] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
Human papillomavirus (HPV) vaccines, which were introduced in many countries in the past decade, have shown promising results in decreasing HPV infection and related diseases, such as warts and precancerous lesions. In this review, we present the updated information about current HPV vaccines, focusing on vaccine coverage and efficacy. In addition, pan-gender vaccination and current clinical trials are also discussed. Currently, more efforts should be put into increasing the vaccine’s coverage, especially in low- and middle-income countries. Provision of education on HPV and vaccination is one of the most important methods to achieve this. Vaccines that target HPV types not included in current vaccines are the next stage in vaccine development. In the future, all HPV-related cancers, such as head and neck cancer, and anal cancer, should be tracked and evaluated, especially in countries that have introduced pan-gender vaccination programs. Therapeutic vaccines, in combination with other cancer treatments, should continue to be investigated.
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Lai L, Ault K, Rouphael N, Beck A, Domjahn B, Xu Y, Anderson EJ, Cheng A, Nakamura A, Hoagland RJ, Kelley C, Edupuganti S, Mask K, Nesin M, Unger ER, Panicker G, David H, Mulligan MJ. Duration of Cellular and Humoral Responses after Quadrivalent Human Papillomavirus Vaccination in Healthy Female Adults with or without Prior Type 16 and/or 18 Exposure. Vaccines (Basel) 2020; 8:vaccines8030348. [PMID: 32629943 PMCID: PMC7563427 DOI: 10.3390/vaccines8030348] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus virus (HPV) vaccines aim to provide durable protection and are ideal to study the association of cellular with humoral responses. We assessed the duration and characteristics of immune responses provided by the quadrivalent HPV (4vHPV) vaccine in healthy female adults with or without prior exposure with type 16 and 18 HPV. In a prospective cohort, vaccine naïve females received three doses of 4vHPV vaccine and were followed for two years to assess cellular (intracellular cytokine staining, proliferation and B cell ELISpot assays) and humoral (multiplex L1/L2 viral-like particles (VLP) and M4 ELISAs) responses. Frequencies of vaccine-specific CD4+ T cells correlated with antibody responses. Higher HPV antibody titers were found at all time points in participants previously exposed to HPV, except for anti-HPV-18 at Day 187 (one week post the third vaccination). Retrospective cohorts enrolled females who had previously received two or three 4vHPV doses and tested antibody titers by M4 ELISA and pseudovirion neutralization assay along with memory B cells (MBCs). Almost all women enrolled in a retrospective cohort with two prior doses and all women enrolled in a retrospective cohort with three prior doses had sustained antibody and memory responses. Our findings indicate that HPV vaccination induces a long-lasting, robust cellular and humoral immune responses.
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Affiliation(s)
- Lilin Lai
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Kevin Ault
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Nadine Rouphael
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
- Correspondence: ; Tel.: +1-404-712-1435
| | - Allison Beck
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Briyana Domjahn
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Yongxian Xu
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA;
| | - Andrew Cheng
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Aya Nakamura
- The EMMES Company, LLC, 401 N. Washington St., Suite 700, Rockville, MD 20850, USA;
| | | | - Colleen Kelley
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Srilatha Edupuganti
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Karen Mask
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
| | - Mirjana Nesin
- Division of Microbiology and Infectious Diseases, NIAID, NIH, 5601 Fishers Lane, Rockville, MD 20892-9825, USA; (M.N.); (H.D.)
| | - Elizabeth R. Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA; (E.R.U.); (G.P.)
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA; (E.R.U.); (G.P.)
| | - Hagit David
- Division of Microbiology and Infectious Diseases, NIAID, NIH, 5601 Fishers Lane, Rockville, MD 20892-9825, USA; (M.N.); (H.D.)
| | - Mark J. Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court Suite 200, Decatur, GA 30030, USA; (L.L.); (A.B.); (B.D.); (Y.X.); (A.C.); (C.K.); (S.E.); (K.M.); (M.J.M.)
- New York University Langone Vaccine Center, Alexandria Center for Life Sciences (West Tower), 430 E 29th St, Room 304, New York, NY 10016, USA
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Wnukowski-Mtonga P, Jayasinghe S, Chiu C, Macartney K, Brotherton J, Donovan B, Hall M, Smith DW, Peterson K, Campbell-Lloyd S, Selvey C, Giles M, Kaldor J, Marshall H. Scientific evidence supporting recommendations on the use of the 9-valent HPV vaccine in a 2-dose vaccine schedule in Australia. ACTA ACUST UNITED AC 2020; 44. [PMID: 32299331 DOI: 10.33321/cdi.2020.44.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The Australian Technical Advisory Group on Immunisation (ATAGI) updated recommendations on the use of human papillomavirus (HPV) vaccines in the Australian Immunisation Handbook in 2018, regarding the use of the recently available 9-valent (9vHPV) vaccine, Gardasil 9, and a 2-dose schedule for young adolescents for HPV vaccines. This report provides an overview of the relevant scientific evidence that underpinned these updated recommendations. The 9vHPV vaccine includes 5 HPV types (HPV 31, 33, 45, 52 and 58) additional to the 4 that are also covered by the 4vHPV (Gardasil) vaccine (HPV 6,11,16,18). Accordingly, the 9vHPV vaccine is expected to prevent an additional 15% of cervical cancers and up to 20% of other HPV-related cancers. Non-inferior antibody responses after two 9vHPV vaccine doses given 6-12 months apart in girls and boys aged 9-14 years compared to women aged 16-26 years after three doses support the 2-dose schedule for adolescents of this age group. In clinical trials 9vHPV vaccine was well-tolerated with a similar safety profile to 4vHPV vaccine. The switch to 9vHPV vaccine and a 2-dose schedule is anticipated to improve public acceptability of the program and reduce HPV-related disease in the long-term.
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Affiliation(s)
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales
| | - Julia Brotherton
- Victorian Cytology Service Population Health, VCS Foundation and School of Population and Global Health, University of Melbourne, Melbourne, Victoria
| | - Basil Donovan
- The Kirby Institute, University of New South Wales and Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales
| | - Madeline Hall
- Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Queensland
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine WA and Faculty of Health and Medical Sciences, University of Western Australia, Nedlands, Western Australia
| | - Karen Peterson
- Immunisation Program, Queensland Health, Brisbane, Queensland
| | - Sue Campbell-Lloyd
- Immunisation Unit, Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, New South Wales
| | - Christine Selvey
- Communicable Diseases Branch, Health Protection NSW, NSW Health, Sydney, New South Wales
| | - Michelle Giles
- The Alfred Hospital and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Sydney, New South Wales
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital and Robinson Research Institute and Adelaide Medical School, University of Adelaide, North Adelaide, South Australia
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Ford ME, Cannady K, Nahhas GJ, Knight KD, Chavis C, Crawford B, Malek AM, Martino E, Frazier S, Gathers A, Lawton C, Cartmell KB, Luque JS. Assessing an intervention to increase knowledge related to cervical cancer and the HPV vaccine. Adv Cancer Res 2020; 146:115-137. [PMID: 32241386 DOI: 10.1016/bs.acr.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Human papillomavirus (HPV) infection is the primary risk factor for cervical cancer. While the HPV vaccine significantly reduces the risk of HPV infection and subsequent cervical cancer diagnosis, underuse is linked to lack of knowledge of its effectiveness in preventing cervical cancer. The purpose of this study was to evaluate a cancer educational intervention (titled "MOVENUP") to improve knowledge of cervical cancer, HPV, and the HPV vaccine among predominantly African American communities in South Carolina. The MOVENUP cancer educational intervention was conducted among participants residing in nine South Carolina counties who were recruited by community partners. The 4.5-h MOVENUP cancer educational intervention included a 30-min module on cervical cancer, HPV, and HPV vaccination. A six-item investigator-developed instrument was used to evaluate pre- and post-intervention changes in knowledge related to these content areas. Ninety-three percent of the 276 participants were African American. Most participants reporting age and gender were 50+ years (73%) and female (91%). Nearly half of participants (46%) reported an annual household income <$40,000 and 49% had not graduated from college. Statistically significant changes were observed at post-test for four of six items on the knowledge scale (P<0.05), as compared to pre-test scores. For the two items on the scale in which statistically significant changes were not observed, this was due primarily due to a baseline ceiling effect.
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Affiliation(s)
- Marvella E Ford
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Associate Director, Population Sciences and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC United States; SmartState Endowed Chair in Cancer Disparities Research, South Carolina State University, Orangeburg, SC, United States.
| | - Kimberly Cannady
- Academic Affairs Faculty, Medical University of South Carolina, Charleston, SC, United States
| | - Georges J Nahhas
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States; Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, United States
| | - Kendrea D Knight
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Courtney Chavis
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Brittney Crawford
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Angela M Malek
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Erica Martino
- Professor, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Starr Frazier
- Department of Biological and Physical Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Antiqua Gathers
- Department of Biological and Physical Sciences, South Carolina State University, Orangeburg, SC, United States
| | - Claudia Lawton
- Institute of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - John S Luque
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, United States
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Nicoli F, Mantelli B, Gallerani E, Telatin V, Bonazzi I, Marconi P, Gavioli R, Gabrielli L, Lazzarotto T, Barzon L, Palù G, Caputo A. HPV-Specific Systemic Antibody Responses and Memory B Cells are Independently Maintained up to 6 Years and in a Vaccine-Specific Manner Following Immunization with Cervarix and Gardasil in Adolescent and Young Adult Women in Vaccination Programs in Italy. Vaccines (Basel) 2020; 8:vaccines8010026. [PMID: 31947611 PMCID: PMC7175219 DOI: 10.3390/vaccines8010026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 12/26/2022] Open
Abstract
Human papillomavirus (HPV) persistent infections are associated with cervical cancer and other HPV-related diseases and tumors. Thus, the characterization of long lasting immunity to currently available HPV vaccines is important. A total of 149 female subjects vaccinated with Cervarix or Gardasil participated to the study and they were stratified according to age (10–12-year-old and 16–20-year-old). Humoral immune responses (IgG and neutralizing antibody titers, antibody avidity) and circulating memory B cells were analyzed after an average of 4–6 years from the third immunization. The humoral responses against HPV-16 and HPV-18 (and HPV-6 and HPV-11 for Gardasil) were high in both age groups and vaccines up to six years from the third dose. However, Cervarix induced significantly higher and more persistent antibody responses, while the two vaccines were rather equivalent in inducing memory B cells against HPV-16 and HPV-18. Moreover, the percentage of subjects with vaccine-specific memory B cells was even superior among Gardasil vaccinees and, conversely, Cervarix vaccinated individuals with circulating antibodies, but undetectable memory B cells were found. Finally, a higher proportion of Cervarix-vaccinated subjects displayed cross-neutralizing responses against non-vaccine types HPV-31 and HPV-45. Gardasil and Cervarix may, thus, differently affect long-lasting humoral immunity from both the quantitative and qualitative point of view.
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Affiliation(s)
- Francesco Nicoli
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy; (F.N.); (E.G.); (P.M.); (R.G.)
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (B.M.); (V.T.); (I.B.); (L.B.); (G.P.)
| | - Barbara Mantelli
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (B.M.); (V.T.); (I.B.); (L.B.); (G.P.)
| | - Eleonora Gallerani
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy; (F.N.); (E.G.); (P.M.); (R.G.)
| | - Valentina Telatin
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (B.M.); (V.T.); (I.B.); (L.B.); (G.P.)
| | - Irene Bonazzi
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (B.M.); (V.T.); (I.B.); (L.B.); (G.P.)
| | - Peggy Marconi
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy; (F.N.); (E.G.); (P.M.); (R.G.)
| | - Riccardo Gavioli
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy; (F.N.); (E.G.); (P.M.); (R.G.)
| | - Liliana Gabrielli
- Operative Unit of Clinical Microbiology, St Orsola-Malpighi University Hospital, 40138 Bologna, Italy;
| | - Tiziana Lazzarotto
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, 40138 Bologna, Italy;
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (B.M.); (V.T.); (I.B.); (L.B.); (G.P.)
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (B.M.); (V.T.); (I.B.); (L.B.); (G.P.)
| | - Antonella Caputo
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, 44121 Ferrara, Italy; (F.N.); (E.G.); (P.M.); (R.G.)
- Department of Molecular Medicine, University of Padova, 35121 Padova, Italy; (B.M.); (V.T.); (I.B.); (L.B.); (G.P.)
- Correspondence: ; Tel.: +39-0532-974410
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Bergman H, Buckley BS, Villanueva G, Petkovic J, Garritty C, Lutje V, Riveros‐Balta AX, Low N, Henschke N. Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males. Cochrane Database Syst Rev 2019; 2019:CD013479. [PMID: 31755549 PMCID: PMC6873216 DOI: 10.1002/14651858.cd013479] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccine remains low in many countries, although the bivalent and quadrivalent HPV vaccines given as a three-dose schedule are effective in the prevention of precancerous lesions of the cervix in women. Simpler immunisation schedules, such as those with fewer doses, might reduce barriers to vaccination, as may programmes that include males. OBJECTIVES To evaluate the efficacy, immunogenicity, and harms of different dose schedules and different types of HPV vaccines in females and males. SEARCH METHODS We conducted electronic searches on 27 September 2018 in Ovid MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library), and Ovid Embase. We also searched the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov (both 27 September 2018), vaccine manufacturer websites, and checked reference lists from an index of HPV studies and other relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) with no language restriction. We considered studies if they enrolled HIV-negative males or females aged 9 to 26 years, or HIV-positive males or females of any age. DATA COLLECTION AND ANALYSIS We used methods recommended by Cochrane. We use the term 'control' to refer to comparator products containing an adjuvant or active vaccine and 'placebo' to refer to products that contain no adjuvant or active vaccine. Most primary outcomes in this review were clinical outcomes. However, for comparisons comparing dose schedules, the included RCTs were designed to measure antibody responses (i.e. immunogenicity) as the primary outcome, rather than clinical outcomes, since it is unethical to collect cervical samples from girls under 16 years of age. We analysed immunogenicity outcomes (i.e. geometric mean titres) with ratios of means, clinical outcomes (e.g. cancer and intraepithelial neoplasia) with risk ratios or rate ratios and, for serious adverse events and deaths, we calculated odds ratios. We rated the certainty of evidence with GRADE. MAIN RESULTS We included 20 RCTs with 31,940 participants. The length of follow-up in the included studies ranged from seven months to five years. Two doses versus three doses of HPV vaccine in 9- to 15-year-old females Antibody responses after two-dose and three-dose HPV vaccine schedules were similar after up to five years of follow-up (4 RCTs, moderate- to high-certainty evidence). No RCTs collected clinical outcome data. Evidence about serious adverse events in studies comparing dose schedules was of very low-certainty owing to imprecision and indirectness (three doses 35/1159; two doses 36/1158; 4 RCTs). One death was reported in the three-dose group (1/898) and none in the two-dose group (0/899) (low-certainty evidence). Interval between doses of HPV vaccine in 9- to 14-year-old females and males Antibody responses were stronger with a longer interval (6 or 12 months) between the first two doses of HPV vaccine than a shorter interval (2 or 6 months) at up to three years of follow-up (4 RCTs, moderate- to high-certainty evidence). No RCTs collected data about clinical outcomes. Evidence about serious adverse events in studies comparing intervals was of very low-certainty, owing to imprecision and indirectness. No deaths were reported in any of the studies (0/1898, 3 RCTs, low-certainty evidence). HPV vaccination of 10- to 26-year-old males In one RCT there was moderate-certainty evidence that quadrivalent HPV vaccine, compared with control, reduced the incidence of external genital lesions (control 36 per 3081 person-years; quadrivalent 6 per 3173 person-years; rate ratio 0.16, 95% CI 0.07 to 0.38; 6254 person-years) and anogenital warts (control 28 per 2814 person-years; quadrivalent 3 per 2831 person-years; rate ratio 0.11, 95% CI 0.03 to 0.38; 5645 person-years). The quadrivalent vaccine resulted in more injection-site adverse events, such as pain or redness, than control (537 versus 601 per 1000; risk ratio (RR) 1.12, 95% CI 1.06 to 1.18, 3895 participants, high-certainty evidence). There was very low-certainty evidence from two RCTs about serious adverse events with quadrivalent vaccine (control 12/2588; quadrivalent 8/2574), and about deaths (control 11/2591; quadrivalent 3/2582), owing to imprecision and indirectness. Nonavalent versus quadrivalent vaccine in 9- to 26-year-old females and males Three RCTs were included; one in females aged 9- to 15-years (n = 600), one in females aged 16- to 26-years (n = 14,215), and one in males aged 16- to 26-years (n = 500). The RCT in 16- to 26-year-old females reported clinical outcomes. There was little to no difference in the incidence of the combined outcome of high-grade cervical epithelial neoplasia, adenocarcinoma in situ, or cervical cancer between the HPV vaccines (quadrivalent 325/6882, nonavalent 326/6871; OR 1.00, 95% CI 0.85 to 1.16; 13,753 participants; high-certainty evidence). The other two RCTs did not collect data about clinical outcomes. There were slightly more local adverse events with the nonavalent vaccine (905 per 1000) than the quadrivalent vaccine (846 per 1000) (RR 1.07, 95% CI 1.05 to 1.08; 3 RCTs, 15,863 participants; high-certainty evidence). Comparative evidence about serious adverse events in the three RCTs (nonavalent 243/8234, quadrivalent 192/7629; OR 0.60, 95% CI 0.14 to 2.61) was of low certainty, owing to imprecision and indirectness. HPV vaccination for people living with HIV Seven RCTs reported on HPV vaccines in people with HIV, with two small trials that collected data about clinical outcomes. Antibody responses were higher following vaccination with either bivalent or quadrivalent HPV vaccine than with control, and these responses could be demonstrated to have been maintained for up to 24 months in children living with HIV (low-certainty evidence). The evidence about clinical outcomes and harms for HPV vaccines in people with HIV is very uncertain (low- to very low-certainty evidence), owing to imprecision and indirectness. AUTHORS' CONCLUSIONS The immunogenicity of two-dose and three-dose HPV vaccine schedules, measured using antibody responses in young females, is comparable. The quadrivalent vaccine probably reduces external genital lesions and anogenital warts in males compared with control. The nonavalent and quadrivalent vaccines offer similar protection against a combined outcome of cervical, vaginal, and vulval precancer lesions or cancer. In people living with HIV, both the bivalent and quadrivalent HPV vaccines result in high antibody responses. For all comparisons of alternative HPV vaccine schedules, the certainty of the body of evidence about serious adverse events reported during the study periods was low or very low, either because the number of events was low, or the evidence was indirect, or both. Post-marketing surveillance is needed to continue monitoring harms that might be associated with HPV vaccines in the population, and this evidence will be incorporated in future updates of this review. Long-term observational studies are needed to determine the effectiveness of reduced-dose schedules against HPV-related cancer endpoints, and whether adopting these schedules improves vaccine coverage rates.
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Affiliation(s)
- Hanna Bergman
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Brian S Buckley
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
- University of PhillipinesDepartment of SurgeryManilaPhilippines
| | - Gemma Villanueva
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Jennifer Petkovic
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
- University of OttawaBruyère Research Institute43 Bruyère StAnnex E, room 312OttawaONCanadaK1N 5C8
| | - Chantelle Garritty
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
- Ottawa Hospital Research InstituteOttawa Methods Centre, Clinical Epidemiology ProgramOttawaOntarioCanadaK1H 8L1
| | - Vittoria Lutje
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | | | - Nicola Low
- University of BernInstitute of Social and Preventive Medicine (ISPM)Finkenhubelweg 11BernSwitzerlandCH‐3012
| | - Nicholas Henschke
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
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Lin Y, Lin Z, He F, Hu Z, Zimet GD, Alias H, Wong LP. Factors influencing intention to obtain the HPV vaccine and acceptability of 2-, 4- and 9-valent HPV vaccines: A study of undergraduate female health sciences students in Fujian, China. Vaccine 2019; 37:6714-6723. [PMID: 31548016 DOI: 10.1016/j.vaccine.2019.09.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little research has been conducted on the intention to obtain HPV vaccine now that the vaccine is approved for use in China. Acceptance of the three HPV vaccines, which differ in valency and price, has never been investigated. METHODS An online cross-sectional survey assessing female undergraduate students' intention to obtain the HPV vaccine and their acceptability of 2-, 4- and 9-valent HPV vaccines (2vHPV, 4vHPV, and 9vHPV, respectively). RESULTS Of a total of 997 complete responses, 55.2% reported intent to obtain the HPV vaccine. Some of the significant factors exerting influence on intent to obtain HPV vaccination were high knowledge score (OR = 1.469, 95% CI:1.087-1.987), perceived high risk of HPV infection (OR = 1.466, 95%CI:1.017-2.114), perception of no serious side effects (OR = 1.562, 95%CI:1.150-2.121), and mass media exposure to HPV vaccination information (OR = 2.196, 95%CI: 1.625-2.966). Socioeconomic status indicators did not significantly influence intent to obtain the HPV vaccine. A higher proportion of respondents were willing to pay for 2vHPV (78.6%) and 4vHPV (68.0%) compared with 9vHPV (49.3%). Socioeconomic status indicators were the strongest correlates of acceptability for all the three vaccines. Exposure to mass media reporting about HPV vaccination is the factor which exerts the most influence on acceptance of 9vHPV after socioeconomic status indicators. CONCLUSIONS It is important to improve knowledge and health beliefs, and to establish a mass media marketing strategy to promote HPV vaccination in order to enhance HPV vaccine uptake. Undergraduate female students should be provided with detailed information about the different valency vaccine choices to help them make informed decisions about immunization.
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Affiliation(s)
- Yulan Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, Fujian Province, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350108, Fujian Province, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, Fujian Province, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350108, Fujian Province, China
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, Fujian Province, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350108, Fujian Province, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, Fujian Province, China; Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350108, Fujian Province, China.
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University, 410 W, 10th St., HS 1001 Indianapolis, IN 46202, United States
| | - Haridah Alias
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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MacIntyre CR, Shaw PJ, Mackie FE, Boros C, Marshall H, Seale H, Kennedy SE, Moa A, Chughtai AA, Trent M, O'Loughlin EV, Stormon M. Long term follow up of persistence of immunity following quadrivalent Human Papillomavirus (HPV) vaccine in immunocompromised children. Vaccine 2019; 37:5630-5636. [DOI: 10.1016/j.vaccine.2019.07.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 01/16/2023]
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Abstract
Data regarding humoral immunity against HPV infection are scarce. Most analyses focus on the identification of viruses on mucous membranes and primarily refer to women of reproductive age. The aim of this work was to estimate the seroprevalence of antibodies against HPV serotypes 6, 11, 16 and 18 among unvaccinated boys living in Mexico City. A cross-sectional study of 257 male students from 48 public primary schools in Mexico City, whose ages fluctuated between 9 and 14 years, was carried out. Immunological status was assessed by applying the competitive Luminex Immunoassay of HPV (cLIA). Among the study population, we initially found that 38.52% (n = 99) of the children tested positive against one or more of the HPV 6, 11, 16 and/or 18 serotypes. The most commonly found serotype was isolated HPV 18 or in combination with other serotypes (22% and 31%, respectively), followed by HPV 6 with frequencies of 4.7% and 11%, respectively; however, lower frequencies were estimated for HPV 16 (2%; 6%) and isolated HPV 11, 4%. If a second set of cut-off points for seropositivity is applied, the overall prevalence for any serotype is reduced to 15.2%. As it appears that a significant sector of the study population has had basal contact with an HPV serotype, we recommend considering the possibility of vaccination against HPV at earlier ages.
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Wong LP, Han L, Li H, Zhao J, Zhao Q, Zimet GD. Current issues facing the introduction of human papillomavirus vaccine in China and future prospects. Hum Vaccin Immunother 2019; 15:1533-1540. [PMID: 31017500 DOI: 10.1080/21645515.2019.1611157] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The introduction of human papillomavirus (HPV) vaccination in China aims to prevent HPV infection in all women. The issues that China might face include high cost of vaccines made in other countries, shortage in HPV vaccine supply, negative events attributed to vaccination (whether justified or not) that jeopardizes the general public's confidence in the HPV vaccine, cultural and literacy barriers, and sensitivity to receiving a vaccine for a sexually transmitted disease. Ensuring the effective delivery of the HPV vaccine in China, a country with vast economic, geographical, and cultural complexities, will require a commitment of significant resources. In light of the high price of imported vaccines, the availability of locally manufactured HPV vaccines would greatly facilitate the national HPV vaccination program. New evidence supporting the efficacy of a two-dose regime in younger adolescents would also be advantageous in terms of affordability and logistical simplicity of vaccine administration. Furthermore, it would potentially enhance the compliance and uptake, especially for hard to reach women in remote regions.
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Affiliation(s)
- Li Ping Wong
- a Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia.,b Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University , Ningbo , Zhejiang , PR China
| | - Liyuan Han
- b Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University , Ningbo , Zhejiang , PR China
| | - Hui Li
- c Non-infectious Disease Prevention and Control Institute, Ningbo Municipal Center for Disease Control and Prevention , Ningbo , PR China
| | - Jinshun Zhao
- b Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University , Ningbo , Zhejiang , PR China
| | - Qinjian Zhao
- d State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University , Xiamen , Fujian PR China
| | - Gregory D Zimet
- e Department of Pediatrics, School of Medicine, Indiana University , Indianapolis , IN , USA
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Satari HI, Sundoro J, Andrijono A, Hadinegoro SR, Syafriyal S, Tandy G, Karolina S. Post Marketing Surveillance Study of 2nd Dose Quadrivalent Human Papilloma Virus Vaccine in Elementary School Children in Jakarta, Indonesia: Safety Result and Implementation of School-Based HPV Immunization Program. Asian Pac J Cancer Prev 2019; 20:869-875. [PMID: 30912406 PMCID: PMC6825787 DOI: 10.31557/apjcp.2019.20.3.869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/09/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: Quadrivalent human papillomavirus (QHPV) vaccine has been advised for routine vaccination of pre-adolescent girls globally, and a two-dose QHPV vaccination schedule has been introduced in Indonesia to vaccinate 5th and 6th grade elementary school female students. This post-marketing surveillance study evaluated the possible adverse events following immunization with the two-dose QHPV vaccine in Indonesia. Methods: Girls studying in grade 6 of five designated elementary schools in Jakarta, receiving their 2nd dose of QHPV vaccine and provided informed consent (represented by their parents), were included in the study. Students who had received other immunizations either simultaneously or <1 month ago were excluded. Local and systemic reactions noted at 30 min, and 72 h to 28th day, after the immunization were recorded using a Children Symptom Dairy Card/Kartu Harian Anak Sekolah (KHAS/ Student Daily Card). Results: A total of 500 students from 20 schools were included. No serious adverse events were reported during the study period. Fever (systemic reaction) of mild intensity was noted in 1.6 % (n=8) of participants, which subsided after day 6. Local reactions such as pain, redness and swelling were noted in 59.6% (n=295), 23.6% (n=118), and 17.2% (n=86) of participants, respectively. These resolved without any intervention in majority of the cases after day 5. Conclusion: These results along with the safety data from the pre-licensure clinical trials confirm the favorable safety profile of QHPV vaccine in pre-adolescent girls. The school-based two-dose QHPV immunization program in Indonesia is a safe and effective strategy for optimizing HPV vaccine coverage among pre-adolescent girls.
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Affiliation(s)
- Hindra Irawan Satari
- National Committee of Adverse Event Following Immunization, MOH, Jakarta, Indonesia
| | - Julitasari Sundoro
- Ministry of Health, Indonesia National Committee on Adverse Event Following Immunization, Jakarta, Indonesia.
| | - Andrijono Andrijono
- Head of Indonesian Society of Gynecologic Oncology (INASGO) and Head of Indonesian Working Group on HPV, Jakarta, Indonesia
| | - Sri Rezeki Hadinegoro
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Syafriyal Syafriyal
- Indonesia Ministry of Health, Immunization Sub-Directorate at Directorate of Surveillance, Immunization and Health Quarantine, Jakarta, Indonesia
| | - Gertrudis Tandy
- Indonesia Ministry of Health, Immunization Sub-Directorate at Directorate of Surveillance, Immunization and Health Quarantine, Jakarta, Indonesia
| | - Sherli Karolina
- Indonesia Ministry of Health, Immunization Sub-Directorate at Directorate of Surveillance, Immunization and Health Quarantine, Jakarta, Indonesia
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Campbell-Tofte J, Vrahatis A, Josefsen K, Mehlsen J, Winther K. Investigating the aetiology of adverse events following HPV vaccination with systems vaccinology. Cell Mol Life Sci 2019; 76:67-87. [PMID: 30324425 PMCID: PMC11105185 DOI: 10.1007/s00018-018-2925-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 12/18/2022]
Abstract
In contrast to the insidious and poorly immunogenic human papillomavirus (HPV) infections, vaccination with the HPV virus-like particles (vlps) is non-infectious and stimulates a strong neutralizing-antibody response that protects HPV-naïve vaccinees from viral infection and associated cancers. However, controversy about alleged adverse events following immunization (AEFI) with the vlps have led to extensive reductions in vaccine acceptance, with countries like Japan dropping it altogether. The AEFIs are grouped into chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). In this review, we present a hypothesis that the AEFIs might arise from malfunctions within the immune system when confronted with the unusual antigen. In addition, we outline how the pathophysiology of the AEFIs can be cost-effectively investigated with the holistic principles of systems vaccinology in a two-step process. First, comprehensive immunological profiles of HPV vaccinees exhibiting the AEFIs are generated by integrating the data derived from serological profiling for prominent HPV antibodies and serum cytokines, with data from serum metabolomics, peripheral white blood cells transcriptomics and gut microbiome profiling. Next, the immunological profiles are compared with corresponding profiles generated for matched (a) HPV vaccinees without AEFIs; (b) non-HPV-vaccinated individuals with CFS/ME-like symptoms; and (c) non-HPV-vaccinated individuals without CFS/ME. In these comparisons, any causal links between HPV vaccine and the AEFIs, as well as the underlying molecular basis for the links will be revealed. Such a study should provide an objective basis for evaluating HPV vaccine safety and for identifying biomarkers for individuals at risk of developing AEFI with HPV vaccination.
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Affiliation(s)
| | | | - Knud Josefsen
- Bartholin Institute, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Jesper Mehlsen
- Coordinating Research Centre, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Kaj Winther
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, DK-2200, Copenhagen N, Denmark
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40
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Šterbenc A, Maver Vodičar P, Poljak M. Recent advances in prophylactic human papillomavirus (HPV) vaccination: a review of key literature published between September 2017 and September 2018. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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41
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Guevara AM, Suarez E, Victoria A, Ngan HY, Hirschberg AL, Fedrizzi E, Bautista O, Shields C, Joshi A, Luxembourg A. Maternal transfer of anti HPV 6 and 11 antibodies upon immunization with the 9-valent HPV vaccine. Hum Vaccin Immunother 2018; 15:141-145. [PMID: 30261146 DOI: 10.1080/21645515.2018.1514227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND This exploratory analysis was conducted to characterize the level of HPV types 6/11 antibodies in peripartum maternal blood and in cord blood of infants born to women who received 9-valent HPV (9vHPV) vaccine or quadrivalent HPV (qHPV) vaccine in a pivotal efficacy study (V503-001, NCT 00543543). METHODS A total of 21 mother-infant pairs had evaluable HPV 6/11 results available for analysis. HPV6/11 antibodies were assessed using competitive Luminex immunoassay. The distribution of the ratios of infant to mother anti-HPV antibodies (i.e., infant-anti-HPV/mother- anti-HPV) was summarized. RESULTS All mothers and infants were seropositive to HPV 6 and HPV 11. Anti-HPV 6/11 geometric mean titers (GMTs) in peripartum maternal blood and in cord blood of infant born to study participants were highly correlated. A 100% of infants born to seropositive mothers were also seropositive. The GMT ratios of peripartum maternal blood vs. those in cord blood were HPV 6: 1.23 [0.43, 3.49] and HPV 11: 1.29 [0.54, 3.07] in the 9vHPV vaccine group and HPV 6: 1.33 [0.41, 4.29] and HPV 11: 1.19 [0.45, 3.13] in the qHPV vaccine group, respectively. CONCLUSIONS These results indicate that antibodies induced by the 9vHPV vaccine cross the placenta, which could potentially be beneficial against HPV6/11 infection and related disease such as recurrent respiratory papillomatosis.
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Affiliation(s)
- Ana Maria Guevara
- a Research Unit , Pablo Tobon Uribe Hospital, Medellin , Antioquia , Colombia
| | - Eugenio Suarez
- b Gynecological Oncology Division , Hospital Clinico San Borja Arriaran Universidad de Chile Campus Centro , Santiago , Chile
| | - Alejandro Victoria
- c Department of Obstetrics and Gynecology , Fundacion Valle del Lili , Cali , Colombia
| | - Hextan Ys Ngan
- d Department of Obstetrics & Gynaecology , The University of Hong Kong , Hong Kong , China
| | - Angelica Lindén Hirschberg
- e Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine , Karolinska University Hospital , Stockholm , Sweden
| | - Edison Fedrizzi
- f Department of Gynecology and Obstetrics , University of Santa Catarina , Florianópolis , Brazil
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Badgujar VB, Ahmad Fadzil FS, Balbir Singh HK, Sami F, Badgujar S, Ansari MT. Knowledge, understanding, attitude, perception and views on HPV infection and vaccination among health care students and professionals in Malaysia. Hum Vaccin Immunother 2018; 15:156-162. [PMID: 30199299 DOI: 10.1080/21645515.2018.1518843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The human papilloma virus (HPV) is known to be a major causative agent of cervical cancers and warts, limited study has been conducted on its associated factors among health care students and professionals in Malaysia. The present study was carried to explore the knowledge, understanding, attitude, perception and views about HPV infection and vaccination. A total of 576 respondents were recruited to complete a self-administered questionnaire through convenience sampling across Malaysia. 80.% and of the females respondents exhibited a positive attitude towards knowledge and understanding and 60% exhibited a positive towards attitude, perception and views. Almost 65% of the population were in agreement that HPV can be transmitted sexually, and 56.7% felt strongly that sexually active persons should essentially be vaccinated. The corresponding values were somewhat lower among the male respondents. Regression analysis suggested that knowledge and understanding were strong associated with gender, age, and occupation. Attitude, perception and views were also evidently associated with gender and age. The Ministry of Health should take steps to improve awareness among the citizens. Efforts should be made to educate people on the risk of HPV as a sexually transmitted diseases associated with HPV, and on the availability of discounted and safe HPV vaccines in government hospitals to increase the uptake rate of HPV vaccines among the Malaysian population.
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Affiliation(s)
- Vishal Bhagwan Badgujar
- a Department of Pharmacy, Faculty of Pharmacy and Health Sciences , Universiti Kuala Lumpur-Royal College of Medicine Perak , Ipoh , Malaysia
| | - Fatin Shahirah Ahmad Fadzil
- a Department of Pharmacy, Faculty of Pharmacy and Health Sciences , Universiti Kuala Lumpur-Royal College of Medicine Perak , Ipoh , Malaysia
| | | | - Farheen Sami
- a Department of Pharmacy, Faculty of Pharmacy and Health Sciences , Universiti Kuala Lumpur-Royal College of Medicine Perak , Ipoh , Malaysia
| | - Sangita Badgujar
- c Department of Pharmacognosy , R.C. Patel Institute of Pharmaceutical Education and Research , Shirpur, Dhule , India
| | - Mohammed Tahir Ansari
- a Department of Pharmacy, Faculty of Pharmacy and Health Sciences , Universiti Kuala Lumpur-Royal College of Medicine Perak , Ipoh , Malaysia
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Choi HCW, Jit M, Leung GM, Tsui KL, Wu JT. Simultaneously characterizing the comparative economics of routine female adolescent nonavalent human papillomavirus (HPV) vaccination and assortativity of sexual mixing in Hong Kong Chinese: a modeling analysis. BMC Med 2018; 16:127. [PMID: 30115065 PMCID: PMC6097427 DOI: 10.1186/s12916-018-1118-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/04/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Although routine vaccination of females before sexual debut against human papillomavirus (HPV) has been found to be cost-effective around the world, its cost-benefit has rarely been examined. We evaluate both the cost-effectiveness and cost-benefit of routine female adolescent nonavalent HPV vaccination in Hong Kong to guide its policy, and by extension that of mainland China, on HPV vaccination. One major obstacle is the lack of data on assortativity of sexual mixing. Such difficulty could be overcome by inferring sexual mixing parameters from HPV epidemiologic data. METHODS We use an age-structured transmission model coupled with stochastic individual-based simulations to estimate the health and economic impact of routine nonavalent HPV vaccination for girls at age 12 on cervical cancer burden and consider vaccine uptake at 25%, 50%, and 75% with at least 20 years of vaccine protection. Bayesian inference was employed to parameterize the model using local data on HPV prevalence and cervical cancer incidence. We use the human capital approach in the cost-benefit analysis (CBA) and GDP per capita as the indicative willingness-to-pay threshold in the cost-effectiveness analysis (CEA). Finally, we estimate the threshold vaccine cost (TVC), which is the maximum cost for fully vaccinating one girl at which routine female adolescent nonavalent HPV vaccination is cost-beneficial or cost-effective. RESULTS As vaccine uptake increased, TVC decreased (i.e., economically more stringent) in the CBA but increased in the CEA. When vaccine uptake was 75% and the vaccine provided only 20 years of protection, the TVC was US$444 ($373-506) and $689 ($646-734) in the CBA and CEA, respectively, increasing by approximately 2-4% if vaccine protection was assumed lifelong. TVC is likely to be far higher when non-cervical diseases are included. The inferred sexual mixing parameters suggest that sexual mixing in Hong Kong is highly assortative by both age and sexual activity level. CONCLUSIONS Routine HPV vaccination of 12-year-old females is highly likely to be cost-beneficial and cost-effective in Hong Kong. Inference of sexual mixing parameters from epidemiologic data of prevalent sexually transmitted diseases (i.e., HPV, chlamydia, etc.) is a potentially fruitful but largely untapped methodology for understanding sexual behaviors in the population.
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Affiliation(s)
- Horace C W Choi
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong.,Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Mark Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.,Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong
| | - Kwok-Leung Tsui
- Department of Systems Engineering and Engineering Management, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Joseph T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, Hong Kong.
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Widdice LE, Bernstein DI. Author Response to Letter: Will increasing dosing intervals decrease the loss of anti-HPV seropositivity over time? Vaccine 2018; 36:4967. [DOI: 10.1016/j.vaccine.2018.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 10/28/2022]
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Abstract
The major impediment to increased human papillomavirus (HPV) vaccination coverage in young males and females is lack of health care provider recommendation. Despite its efficacy in preventing cervical cancer, HPV vaccination in females (49.5%) and males (37.5%) ages 13 through 17 falls well below the Centers for Disease Control and Prevention's (CDC) Healthy People 2020 target of 80% coverage. Parents' willingness to vaccinate their child has been shown to be much higher when physicians share personal vaccination decisions for their own children as well as what other parents have done at that particular clinic. Furthermore, the vaccine must be presented presumptively as a "bundle" along with the rest of the standard adolescent vaccine panel. Multiple exemplars presented including in several European countries, low-income countries and Rwanda, demonstrate that school-based health care systems dramatically increase vaccination coverage. Finally, acceptability for vaccination of males must improve by increasing provider recommendation and by presenting the HPV vaccine as a penile, anal and oropharyngeal cancer prevention therapy in males and not merely a vaccine to prevent cervical cancers in females. Paediatricians, obstetrician/gynaecologists and primary care physicians should consider these data as a call-to-action. Key messages • Despite recent efforts in the US, only 49.5% of females and only 37.5% of males ages 13 through 17 have received all recommended HPV vaccine doses. These numbers fall well below the 80% target set forth by the Healthy People 2020 initiative. • According to the CDC, if health care providers increase HPV vaccination rates in eligible recipients to 80%, it is estimated that an additional 53,000 cases of cervical cancer could be prevented during the lifetime of those younger than 12 years. Furthermore, for every year that the vaccination rate does not increase, an additional 4400 women will develop cervical cancer. • First and foremost, healthcare providers (HCPs) must make a strong recommendation to vaccinate patients and these recommendations must become routine, including for males. • It is clear that HPV vaccination rates improve significantly when vaccine administration occurs at designated, well-organized sites such as school-based vaccination programmes. Furthermore, HPV vaccination should be a high school requirement and offered in the standard adolescent vaccine panel as a bundle with Tdap and MenACWY vaccines in order to promote maximum adherence. • Finally, research on immunogenicity and antibody titre longevity needs to be done in newborns. The HPV vaccine may be recommended in the newborn panel of vaccines to avoid any issues of sexualization and misplaced fears of sexual disinhibition, akin to the success of the Hepatitis B vaccine in the 1980s. • The HPV vaccine is a vaccine against cancer and should be aggressively marketed as such. As healthcare providers, we need to make every effort to overcome barriers, real or perceived, to protecting our population from potential morbidity and mortality associated with this virus.
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Affiliation(s)
- Aria C Attia
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Judith Wolf
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
| | - Ana E Núñez
- a Department of Medicine , Drexel University College of Medicine , Philadelphia , PA , USA
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Mok CC, Ho LY, To CH. Long-term immunogenicity of a quadrivalent human papillomavirus vaccine in systemic lupus erythematosus. Vaccine 2018; 36:3301-3307. [PMID: 29699792 DOI: 10.1016/j.vaccine.2018.04.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the 5-year immunogenicity of a quadrivalent human papillomavirus (HPV) vaccine (GARDASIL) in patients with systemic lupus erythematosus (SLE). METHODS Female SLE patients and controls, aged 18-35 years, who received GARDASIL in 2011 and sero-converted 12 months post-vaccination were followed for persistence of immunogenicity. Antibody measurement to HPV serotypes 6, 11, 16, 18 was repeated at 5 years. The rate of sero-reversion was compared between patients and controls, and factors associated with sero-reversion of the anti-HPV antibodies were studied. RESULTS 50 SLE patients and 50 controls were vaccinated with GARDASIL. Among subjects who sero-converted at 1 year and consented for this study, antibodies to HPV serotypes 6, 11, 16 and 18 at 5 years were persistent in 24/27 (89%), 26/31 (84%), 32/34 (94%) and 24/25 (96%) of the SLE patients; and 32/33 (97%), 32/33 (97%), 32/32 (100%) and 23/24 (96%) of the controls, respectively. Antibody titers to HPV-6 and 16 were significantly lower in patients than controls. Seven (21%) SLE patients had sero-reversion of ≥1 anti-HPV antibodies. Sero-reverted patients experienced significantly more SLE flares, particularly renal, and had received significantly higher cumulative doses of prednisolone, mycophenolate mofetil and tacrolimus than those with persistent immunogenicity. The cumulative doses of prednisolone correlated inversely and significantly with the anti-HPV 6, 11, and 16 titers at 5 years. CONCLUSIONS Immunogenicity of the quadrivalent HPV vaccine was retained in a high proportion of SLE patients at 5 year. Patients with more SLE renal flares and had received more immunosuppression were more likely to have sero-reversion of the anti-HPV antibodies. CLINICAL TRIAL REGISTRATION NUMBER US ClinicalTrials.gov (NCT00911521 & NCT02477254).
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Affiliation(s)
- C C Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong.
| | - L Y Ho
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - C H To
- Department of Medicine, Tuen Mun Hospital, Hong Kong
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Human Vaccines & Immunotherapeutics: News. Hum Vaccin Immunother 2018; 14:9-10. [PMID: 29324172 DOI: 10.1080/21645515.2018.1419757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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