Awareness of HPV and HPV vaccine and willingness to be vaccinated among parents of children aged 9-14 / 公共卫生与预防医学

Objective To investigate the HPV vaccination status of children aged 9-14 years, parents’ vaccine-related cognition, willingness to vaccinate children and their influencing factors. Methods From January to April 2021, the convenience sampling method was used to collect data based on the online platform and the Department of Pediatrics and Adolescent Gynecology of the Children's Hospital of Zhejiang University School of Medicine. The data were analyzed by descriptive analysis, Chi-square test, and logistic regression. Results A total of 864 questionnaires were collected, and 846 valid questionnaires were obtained after screening, with an effective rate of 97.9%. 13.57% of mothers and 3.09% of girls were vaccinated, and the vaccine awareness rate was 68.43%. 87.22% of parents were willing to bring their children for vaccination. Risk perception (OR=4.79, 95% CI: 2.22-10.35), willingness to vaccinate themselves (OR =29.01, 95% CI: 12.62-66.69), awareness of sex education (OR =3.73, 95% CI: 1.08-12.83) and whether the vaccines were free (P<0.001) were related to whether parents were willing to vaccinate their children. Conclusion Parents of children aged 9-14 have high awareness of HPV and HPV vaccine and are willing to vaccinate their children with HPV vaccine , but the vaccination rate in children is low. Disease perception, willingness to vaccinate, awareness of sex education, and whether vaccines are free are all the factors influencing parents' willingness to vaccinate children.

Shanghai responding WHO acceleration in eliminating of cervical cancer / 上海预防医学

World Health Organisation proposed to accelerate the elimination of cervical cancer worldwide at the end of 2020. To achieve the goal of "global elimination of cervical cancer"， this paper described the progress and effectiveness of cervical cancer prevention and control in Shanghai since the 1950s， and summarized the achievements of cervical cancer prevention and control in Jing’an， Jiangxi Province， aiming to provide evidence and experience for better prevention and control of cervical cancer in Shanghai， and then help the world to eliminate cervical cancer.

Importancia de los márgenes quirúrgicos afectados en la conización uterina cervical / Importance of surgical margins affected in cervical uterine conization

Resumen: OBJETIVO: Determinar la asociación entre los márgenes afectados con la persistencia-recurrencia de neoplasia intraepitelial cervical, persistencia del virus del papiloma humano y las reintervenciones. MATERIALES Y MÉTODOS: Estudio de casos y controles anidado en una cohorte retrospectiva del Complexo Hospitalario Universitario de Ourense (enero 2010-octubre 2017). Criterio de inclusión: mujeres con al menos una revisión postintervención. Criterios de exclusión: mujeres sin evidencia de displasia de alto grado en la pieza de conización y a las que no se dio seguimiento. Variables de estudio: edad, tabaquismo, preservativo, anticonceptivos orales, vacunación contra VPH, persistencia-recurrencia de NIC y de VPH y reintervención. Se realizaron pruebas paramétricas y no paramétricas entre las variables. RESULTADOS: La cohorte se integró con 248 mujeres, de éstas 81 (32.6%) tuvieron afectación de los márgenes quirúrgicos en la conización. La inmunosupresión, el tabaquismo y la anticoncepción oral fueron las asociaciones más frecuentes en los márgenes afectados. El uso de preservativo y la vacunación contra VPH fueron significativamente más frecuentes en los márgenes libres. Los márgenes afectados reportaron mayor persistencia de VPH (50 vs 23.9%; OR 3.17 (1.90-5.26), p < 0.001), enfermedad persistente-recurrente (47.2 vs 22.5%; OR 3.07 (1.84-5.12), p < 0.001) y reintervenciones (40.2 vs 15.4%; OR 3.679 (2.094-6.463), p < 0.028). El margen más afectado fue, en orden descendente, endocervical (55.6%), exocervical (25%) y ambos (19.4%). CONCLUSIONES: El margen afectado confiere un riesgo importante en la evolución de la infección por VPH y la recurrencia de la enfermedad.

Abstract: OBJECTIVE: To determine the association between affected margins with persistence-recurrence of cervical intraepithelial neoplasia, persistence of human papillomavirus and re-interventions. MATERIALS AND METHODS: Study of cases and controls nested in a retrospective cohort of the Complexo Hospitalario Universitario de Ourense (January 2010-October 2017). Inclusion criteria: women with at least one post-intervention check-up. Exclusion criteria: women without evidence of high-grade dysplasia in the conization piece and who were not followed up. Study variables: age, smoking, condom, oral contraceptives, HPV vaccination, persistence-recurrence of CIN and HPV, and re-operation. Parametric and non-parametric tests were performed among the variables. RESULTS: The cohort consisted of 248 women, 81 of whom (32.6%) had affected surgical margins on conization. Immunosuppression, smoking and oral contraception were the most frequent associations in affected margins. Condom use and HPV vaccination were significantly more frequent in free margins. Affected margins reported greater persistence of HPV (50 vs 23.9%; OR 3.17 (1.90-5.26), p < 0.001), persistent-recurrent disease (47.2 vs 22.5%; OR 3.07 (1.84-5.12), p < 0.001), and reinterventions (40.2 vs 15.4%; OR 3.679 (2.094-6.463), p < 0.028). The most affected margin was, in descending order, endocervical (55.6%), exocervical (25%) and both (19.4%). CONCLUSIONS: The affected margin confers a significant risk in the evolution of HPV infection and disease recurrence.

Factors influencing the acceptance of HPV vaccine among civil servants in Delta State Secretariat

Background: The importance of cervical screening and HPV vaccination cannot be overemphasized. Yet, the level of uptake of HPV vaccination has never been evaluated among Secretariat personnel in Delta State of Nigeria. This part-of-four piece of study aimed to identify the barriers to the acceptance of HPV vaccination in Delta State, Nigeria.Methods: A cross-sectional, descriptive survey method was adopted using a structured questionnaire. 285 participants were included. The structured questionnaire included questions on acceptance of HPV vaccination and the factors influencing acceptability. Statistical analysis included percentage proportions of respondents. Absolute and relative frequencies of the factors were also determined. Chi-squared analysis was performed based on dichotomy of participants based on yes/no response to being vaccinated.Results: Less than 8% of respondents have completed the HPV vaccination program. Low income earners have accepted the vaccination more than the high income group (p <0.003). Nature of work implying time constraints was an absolute factor. Accessibility is one of four factors that were significantly associated (p <0.002).Conclusions: Given the observation on nature of work and associated implication of time constraints and also inaccessibility as potentially major factors; it suffices to suggest that acceptance of HPV vaccination may be improved by expounding the days and sites of vaccination programs to be closer to the offices and scheduled around lunch-break times.

Demographics and knowledge of cervical cancer of female civil servants in Delta State on Nigeria

Background: Delta state of Nigeria is a typical micro-world of multicultural values and religious beliefs as well as socioeconomic strata that could impact on the uptake of cervical cancer screening and HPV vaccination. Yet, the demographics of women in conjunction with knowledge and perception of cervical cancer screening have not been surveyed. This study aimed to assess the demographics of civil service women servants in Delta State and their knowledge regarding cervical cancer.Methods: The study was a questionnaire-based cross-sectional survey of female civil servants in the states’ capital city of Asaba. Structured questionnaire was used to collect data on eight demographic factors (age, educational level, ethnicity, income level, marital status, number of children, religion and workplace); as well as information on knowledge of cervical. Percentage proportions of respondents were assessed for the eight demographic factors. Absolute frequencies of affirmative responses to the questions on knowledge were evaluation. Hypothesis was tested for statistical significance of the demographic variables.Results: Analysis of the respondents (N=285) show that virtually all participants have heard of cervical cancer and knows that sexual promiscuity is a risk of the health condition. Only less than 5% of them attribute healthcare workers as their source of knowledge. Except age and marital status, every demographic variable is significant (p<0.05).Conclusions: Demographics of women are significant in terms of potential factors that could influence the uptake of HPV vaccination and cervical cancer screening.

Cervical cancer screening, HPV vaccine: Knowledge and attitudes of female adolescents seeking consult at Philippine Children's Medical Center

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>This study aims to assess the knowledge and attitudes of female adolescents aged 14-19 years old seeking consult at Philippine Children's Medical Center regarding cervical cancer screening and HPV vaccine.</p><p style="text-align: justify;"><strong>DESIGN: </strong>Cross-sectional survey of mid to late adolescents.</p><p style="text-align: justify;"><strong>METHODOLOGY: </strong>The survey questionnaire consists of 18 items in the domain of knowledge, attitudes, practice behaviors, barriers and demographic information. Survey forms in a sealed envelope were given to adolescents 14 to 19 years old after obtaining their assent and parents/guardians' consent.</p><p style="text-align: justify;"><strong>RESULTS: </strong>There were a total of 107 respondents; majority belonged to the mid adolescents (14-16 years old), high school level and non sexually active 57%, 64% and 62% respectively. Most of the respondents (60%) were in a relationship or had a boyfriend, 61% engaged in a monogamous sexual relationship with their partners, 10% had 2 partners and 15% had more than 3 partners. There were significantly more late adolescents who are sexually active compared to mid adolescents (67.4% and 14.8%). Awareness of cervical cancer screening is only 23% of the surveyed adolescents (mean age 16.36). Majority of the sexually active respondents knew that HPV infection is through vaginal intercourse, and that pap smear is necessary even if no history of cancer in the family. More respondents with high education knew that avoidance of sexual intercourse, using condom and vaccination are all effective methods of HPV infection prevention. 53% of the respondents heard about HPV vaccine. Sources of information were mostly from the mass media. Majority were willing to receive the vaccine especially if given for free.</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>Knowledge on HPV and Cervical cancer prevention especially through pap smear is poor. Health education and improvement of personal practices should be emphasized as necessary factors for preventing HPV infection acquisition.</p>

Factors Influencing Maternal Acceptance of Human Papillomavirus Vaccination for Their School-Aged Daughters in Fukuoka Prefecture, Japan.

Aims: The aim of this study was to elucidate the factors that influence maternal acceptance of human papillomavirus (HPV) vaccination for their school-aged daughters. Study Design: The survey was cross-sectional and conducted using an anonymous selfadministered questionnaire. Place and Duration of Study: Two middle schools and 10 high schools in Fukuoka prefecture, between November 2012 and April 2013. Methodology: The cross-sectional survey was conducted on mothers (n=1,407) with daughters aged 13-16 years, and an anonymous self-administered questionnaire was used. The items were HPV vaccination status of daughter, knowledge of the HPV vaccine and cervical cancer, attitude toward the HPV vaccine and general vaccinations, and communication with daughters about cervical cancer. The questionnaire was distributed and collected through the junior high school students and the high school students. Variables were extracted related to the daughters’ state of vaccination, and subsequently multivariate logistic regression analysis was performed. Results: Eight factors of mothers were extracted related to daughters’ HPV vaccination in order of strong influential: attitude placing importance on cost-free vaccination (OR, 9.26; 95% CI,3.42- 25.0), sense of parental obligation (OR, 4.65; 95% CI, 2.30-9.43), trust in the effectiveness of vaccine (OR, 3.91; 95% CI,2.41-6.34), trust in the government’s handling of vaccination (OR, 2.40; 95% CI,1.49-3.86), communication with daughters (OR, 2.04; 95%CI, 1.28-3.22), trust in the safety of vaccine (OR, 1.81; 95% CI,1.04-3.15), threat of cervical cancer (OR, 1.80; 95% CI,1.14-2.86), and knowledge of the HPV vaccine (OR,1.23; 95%CI, 1.06-1.43). Conclusion: HPV vaccination of school-aged girls was promoted by passive factors of mothers: attitude toward free vaccination through a public subsidy and a sense of parental obligation. Further enhancement of education for HPV prevention is urgently needed.

Extending Quadrivalent Human Papilloma Virus (HPV) Vaccination To Males

Introduction: Human papilloma virus (HPV)-related genital warts and cancers can lead to significant morbidity. The ACIP 2011 from the United States recommends routine quadrivalent HPV vaccination for both males and females for primary prevention.1 This study reviews current evidence on vaccinating males routinely, and determines if it can be applied to Singapore. Methods: Relevant articles from PubMed were obtained by searches using the search words “quadrivalent HPV vaccination”, “males”, “cancer” and “prevention”. Three retrieved articles are included in this review and 3 additional articles are included from the references of the selected articles. Results: Quadrivalent HPV vaccination is effective in the primary prevention of HPV-related genital warts and cancers in both genders. Effectiveness in the secondary prevention of HPV-related recurrent high-grade intra-epithelial neoplasia(HGAIN) was suggested in a cohort study among men. The vaccine is safe with minor side effects of localised injection site pain. Conclusion: Given the efficacy and safety of quadrivalent HPV vaccination in both males and females, local studies should be done to confirm the benefits of routine vaccination.

Human papilloma virus vaccination: practical guidelines.

Cervical cancer has a long latency period and established role of HPV lead to interest in development of HPV vaccine. Main goal of HPV vaccination is to decrease cervical cancer incidence. There are two vaccines available, for the prevention of HPV infection - gardasil and cervarix. Gardasil is quadrivalent and cervarix is bivalent. The FDA has approved gardasil in 2006 and cervarix in 2009 based on their efficacy in phase 3 trails. When recommending HPV immunization of females, it should be offered to girls 11 to 12 years of age, but can be administered as early as nine years. Catch-up vaccination should be offered for females aged 13 to 26 years who have not been previously vaccinated. HPV immunization is not effective in clearing cytological evident disease or HPV infection that is already present and it does not provide immunization for serotypes other than included in vaccine. Cervical cancer screening is recommended to continue as per guidelines.

Vacina como agente de imunização contra o HPV / Vaccines as an agent for immunization against HPV

Considerada uma infecção de alta prevalência em todo o mundo, o papiloma vírus humano (HPV) é um DNA vírus que infecta a mucosa genital e possui grande potencial oncogênico, sendo relacionado ao risco aumentado de lesões do trato genital inferior, como o câncer cervical. Este câncer é responsável pela morte de cerca de 231 mil mulheres por ano no mundo, o que torna o HPV um grande problema para a saúde pública. Sabendo que a maneira mais eficaz e com melhor custo-benefício para controlar uma doença infecciosa é o desenvolvimento de vacinas, duas profiláticas foram desenvolvidas e aprovadas no Brasil, uma bivalente e outra quadrivalente. Essa revisão de literatura se propõe a apresentar as características do vírus HPV, os tipos de vacinas presentes no mercado, suas indicações e contraindicações, seus efeitos adversos, sua eficácia, seus títulos de anticorpos (GMT) e seu custo-efetividade.

Considered a highly prevalent infection throughout the world, the human papillomavirus (HPV) is a DNA virus that infects the genital mucosa and has high carcinogenic potential, being related to an increased risk of lower genital tract lesions, such as cervical cancer. This cancer is responsible for the deaths of about 231,000 women per year worldwide, which means that HPV is a major problem for public health. Knowing that the most effective and cost-effective way to control an infectious disease is the development of vaccines, two prophylactic vaccines have been developed and approved in Brazil, one of which is bivalent and the other is tetravalent. This review of the literature seeks to present the characteristics of the HPV virus, types of vaccines available on the market, their indications and contraindications, their adverse effects, their effectiveness, their geometric mean titer (GMT) and their cost-effectiveness.

Economic burden of cervical cancer in Malaysia.

Cervical cancers form the second highest number of female cancers in Malaysia, imposing a substantial amount of cost burden on its management. However, an estimation of cost burden of abnormal smears, cervical pre-invasive and invasive diseases needs to be done to show how much spending has been allocated to the problem. An expert panel committee came up with the clinical pathway and management algorithm of cervical pre invasive and invasive diseases from July-December 2006 Malaysia. An activity based costing for each clinical pathway was done. Results were converted to USD. The cost of managing pre-invasive cervical cancers stage is USD 420,150 (Range: USD 197,158-879,679). Management of invasive cancer (new cases) costs USD 51,533,233.44 (Range: USD 32,405,399.69 - USD 129,014,768.40). The cost of managing existing cases is USD 17,005,966.87 (Range: USD 10,693,781.90 - USD 28,901,587.12). The total cost of managing cervical cancers by health care providers in a public setting is around USD 75,888,329.45 (Range: USD 48,083,804.60 - USD 48,083,804.60). The outcome of this study has shown that preventive modalities such as screening have only contributed to 10.3 % of the total management cost of cervical cancer. The major cost contribution (67%) came from treatment of invasive cancer especially at more advanced stages of cancer, followed by treatment of existing cases (22%) and lastly on pre-invasive disease (0.6%). This study revealed that proportion of preventive modality in this country was still low, and the major cost came from actual treatment cost of cervical cancer. Therefore, heightened public cervical cancer screening in the country is needed.