Ten years of anti-HPV vaccinations: what do we know?

Human papillomavirus vaccination rates in adolescents with cerebral palsy compared to the general population

PURPOSE

To determine whether adolescents with cerebral palsy (CP) initiate and are up-to-date with the human papillomavirus (HPV) immunization series compared to adolescents in the general population.

METHODS

Data on initiation and up-to-date status of the HPV series were collected on adolescents with CP aged 13-17 years old (n = 74) via retrospective medical record review and compared to 616 age-matched peers from the National Immunization Survey, Teen 2019. Analysis by gender, Gross Motor Functional Classification System (GMFCS) level, and ambulatory status was performed in the CP group.

RESULTS

Adolescents with CP were three times less likely to start (p < 0.001) and two times less likely to be up-to-date (p = 0.004) with the HPV immunization series compared to age-matched peers. When the HPV immunization series was initiated in adolescents with CP, these adolescents were as likely to complete the series (p = 0.400), with 83.3% being up-to-date. In those with CP, there was no statistical difference in status of the HPV immunization series when comparing gender, GMFCS level, or ambulatory status.

CONCLUSION

Adolescents with CP were less likely to start the HPV immunization series; however, they were as likely to be up-to-date with the series if it was initiated. This presents an opportunity for pediatric physiatrists to help reduce the disparity.

Update on Safety and Efficacy of HPV Vaccines: Focus on Gardasil

The human papillomavirus (HPV) is a highly contagious and prevalent virus that is primarily sexually transmitted. The Gardasil® quadrivalent vaccine, the Cevarix® bivalent vaccine and the Gardasil® 9 nonavalent vaccine were developed to prevent the spread of HPV as well as the incidence of its associated diseases. The aim of this mini-review is to critically analyze the safety and efficacy of both the Gardasil vaccines. A literature search was conducted on ProQuest, MedLine, Science Direct and Scopus databases. More than hundred articles were scanned, and from this, 38 most relevant papers involving human studies across several countries were closely reviewed. The literature deems the Gardasil® HPV vaccines to be safe and efficacious. Due to the novel nature of these vaccines, long-term efficacies, as well as their associated long-term adverse effects, are yet to be confirmed. Of some concern was the finding that a majority of these studies disclosed minor to major involvement with the vaccine manufacturers, and the inhibitory cost of use in developing nations. Gardasil is largely considered safe to use. However, considering that these vaccines are predominantly indicated for children, further comprehensive, impartial, and long-term studies are needed to critically assess safety and efficacy.

HPV vaccine for men: Where to? (Review)

Human papillomavirus (HPV) is one of the most widespread human pathogens. For a long time, it was treated as an opportunistic infection, but it is in actuality one of the most dangerous carcinogens. It is responsible for numerous malignancies: Cervical, penile, oropharyngeal, vaginal, vulvar and some anal neoplasia. The need for a long-term solution was evident and thus HPV vaccines were proven to be a viable solution. Women and men who have sex with men, and young men are included in the vaccination template. A thorough review using PubMed and other databases that included articles on vaccine templates and targeted male patients was carried out. After review of all of the studies conducted on this subject, there is a clear benefit for HPV vaccination for men. Yet, even with the introduction of a national vaccine program for HPV for women and girls in most developed countries, regarding the male vaccine program, few countries have established a national program. Still, a gender-neutral vaccine remains a controversial issue. It is important to monitor the impact of HPV vaccine in men and the benefits that occur, to inform and spread the results in order to implement this vaccine program worldwide. Any monitoring plan regarding the HPV vaccination must include HPV prevalence, anogenital warts, and anal cancer. The largest impact regarding the range of this type of vaccine is the surveillance of the specific targeted population. HPV vaccine is a very efficient immunization method. Women are obviously the first target, but there are still many contradictions regarding men. Most of the reasons reside in the cost-efficiency aspect, but there is still great debate regarding the most efficient vaccine in the male population.

Awareness of primary health care physicians about human papilloma virus infection and its vaccination: a cross-sectional survey from multiple clinics in Saudi Arabia

Background

The incidence of human papilloma virus (HPV) infections in conservative populations is increasing, yet vaccination is not routinely recommended by primary health care (PHC) physicians. The aim of this study is to evaluate PHC physicians’ awareness of HPV infections and vaccination in Saudi Arabia.

Materials and methods

A self-administered survey was conducted in 2017 at eleven PHC clinics in Saudi Arabia. Their knowledge on HPV infections (six statements) and HPV vaccines (ten statements), their perceived importance of HPV vaccine, and if they recommended this vaccine to their patients was evaluated. Knowledge scores were summated and commuted into percentage mean scores (PMS). Analyses were conducted to identify factors associated with these outcomes.

Results

Almost 80% of physicians perceived HPV vaccine as necessary and important, while 33 (16.5%) actually recommend HPV vaccine to their patients. Overall PMS± standard deviation of knowledge on HPV infections and vaccine was 61.8±10.4 and 91.3±11.4, respectively. Female physicians had a better perception of the importance of the vaccine (94; 84.7%), compared to male physicians (65; 73.0%), P=0.043. Younger physicians (<38 years) had better perception of the importance of HPV vaccine (75; 88.2%), compared to older physicians (≥38 years) (84; 73%), P=0.009. Family medicine physicians were more knowledgeable about both HPV infections (62.1±9.7) and HPV vaccine (91.2±12.0), compared to physicians of other specialties (56.3±13.7 and 85.8±10.2), P=0.03 and P=0.007, respectively. PHC physicians who routinely recommended HPV vaccine were also more knowledgeable (96.7±5.4), P=0.005. Compared to males, females were 3.1 times more likely to recommend HPV vaccines, adjusted P=0.015. Physicians who had better perception of the importance of vaccine were 4.8 times more likely to recommend vaccination, adjusted P=0.042.

Conclusion

Enhancing PHC physicians’ knowledge about HPV infections and the efficiency of its vaccine boosts the physicians’ confidence to recommend HPV vaccination. Special consideration should be paid to male PHC physicians and older physicians, who had poorer perception of the importance of HPV vaccines in comparison to their counter groups.

Early use of the HPV 2-dose vaccination schedule: Leveraging evidence to support policy for accelerated impact

Although human papillomavirus (HPV) vaccines were initially licensed based on efficacy after three-dose regimens in women aged 15-26 years, it was recognized early in clinical development that comparable immunogenicity could be obtained after just two doses when administered to younger girls. In both Canada and Mexico, public health authorities made the decision to administer two doses 6 months apart with a planned additional dose at 60 months, while simultaneously doing further study to determine if the third dose would confer meaningful additional benefit. This delayed third dose approach permitted a more cost-effective program with opportunities for improved compliance while minimizing injections and leaving open the opportunity to provide a full three-dose vaccination series. It required close cooperation across many governmental and civil society leadership bodies and real-time access to emerging data on HPV vaccine effectiveness. Although still limited, there is increasing evidence that even one-dose vaccination is sufficient to provide prolonged protection against HPV infection and associated diseases. Ongoing clinical trials and ecological studies are expected to consolidate existing data regarding one dose schedule use. However, to accelerate the preventive effect of HPV vaccination some jurisdictions, in particular those with limited resources may already consider the initiation of a one dose vaccination with the possibility of giving the second dose later in life if judged necessary. Such an approach would facilitate vaccination implementation and might permit larger catch-up vaccination programs in older girls (or as appropriate, girls and boys), thereby accelerating the impact on cervical cancer and other HPV-associated diseases.