A autonomia do adolescente em relação ao direto de imunização contra infecções sexualmente transmissíveis: revisão bibliográfica / La autonomía de los adolescentes en relación con la inmunización directa contra las infecciones de transmisión sexual: revisión bibliográfica / The autonomy of adolescents in relation to the direct of immunization against sexually transmitted infections: bibliographic review

O presente estudo trata-se de uma análise na literatura sobre o aspecto bioético da autonomia em relação a imunização contra Hepatite B e HPV na adolescência. Foi realizada uma revisão bibliográfica baseada no método prisma onde foram incluídos artigos em português e inglês os quais foram pesquisados nas plataformas Scientific Electronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e National Library of Medicine (PUBMED), utilizando os seguintes descritores Hepatitis B Vaccines, bioethics, Humans. Os resultados demostraram a eficiência dos profissionais de saúde no contato com o indivíduo e o convencimento deste através de um diálogo aberto e criação de vínculos. Evidenciou-se ainda o estudo evidenciou o direito a autonomia progressiva do paciente, no qual este ganha o direito a algumas escolhas como as imunizações de doenças sexualmente transmissíveis, como é o caso da Hepatite B e HPV, no entanto é necessário que o adolescente seja instruído sobre a imunização. Assim sendo, reconhece-se o direito a autonomia progressiva do adolescente, referente a escolha das imunizações contra a Hepatite B e HPV, entretanto, deve-se considerar que estes indivíduos sejam instruídos sobre os benefícios individuais e/ou coletivos da vacinação, contemplados por atividades de educação em saúde por profissionais qualificados, objetivando ampliar a cobertura global de imunização com doenças que caracterizam problemas de saúde pública.

El presente estudio es un análisis de la literatura sobre el aspecto bioético de la autonomía en relación con la inmunización contra la Hepatitis B y el VPH en la adolescencia. Se realizó una revisión bibliográfica basada en el método del prisma, que incluyó artículos en portugués e inglés que fueron buscados en la Biblioteca Científica Electrónica en Línea (SciELO), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) y la Biblioteca Nacional de Medicina (PUBMED), utilizando los siguientes descriptores Vacunas Hepatitis B, bioética, Humanos. Los resultados demostraron la eficiencia de los profesionales de la salud en contactar al individuo y convencerlo a través de un diálogo abierto y creación de vínculos. También se evidenció que el estudio evidenció el derecho del paciente a la autonomía progresiva, en la que adquiere el derecho a algunas opciones como las inmunizaciones de enfermedades de transmisión sexual, como la Hepatitis B y el VPH, sin embargo, es necesario que el adolescente sea educado sobre la inmunización. Por lo tanto, se reconoce el derecho del adolescente a la autonomía progresiva, en cuanto a la elección de las vacunas contra la Hepatitis B y el VPH, sin embargo, se debe considerar que estos individuos sean educados sobre los beneficios individuales y/o colectivos de la vacunación, contemplados por las actividades de educación en salud por profesionales calificados, con el objetivo de ampliar la cobertura mundial de inmunización con enfermedades que caracterizan los problemas de salud pública.

The present study is an analysis of the literature on the bioethical aspect of autonomy in relation to immunization against Hepatitis B and HPV in adolescence. A bibliographic review was carried out based on the prism method, which included articles in Portuguese and English which were searched on the Scientific Electronic Library Online (SCIELO), Latin American and Caribbean Literature on Health Sciences (LILACS) and the National Library of Medicine (PUBMED), using the following descriptors Hepatitis B Vaccines, bioethics, Humans. The results demonstrated the efficiency of health professionals in contacting the individual and convincing him/her through an open dialogue and creation of bonds. It was also evidenced the study evidenced the patient's right to progressive autonomy, in which he gains the right to some choices such as immunizations of sexually transmitted diseases, such as Hepatitis B and HPV, however it is necessary for the adolescent to be educated about immunization. Therefore, the adolescent's right to progressive autonomy is recognized, regarding the choice of immunizations against Hepatitis B and HPV, however, it must be considered that these individuals are instructed on the individual and/or collective benefits of vaccination, contemplated by health education activities by qualified professionals, aiming to expand the global coverage of immunization with diseases that characterize public health problems.

Vacunas terapéuticas del virus del papiloma humano: revisión de la evidencia actual / Therapeutic vaccines of the human papilloma virus: current evidence review

Resumen: OBJETIVO: Evaluar la inmunogenicidad de los distintos tipos de vacunas terapéuticas y de su efecto en las lesiones causadas por el virus del papiloma humano (VPH) después de su aplicación. Además, analizar los estudios de seguridad y las perspectivas de las vacunas terapéuticas contra el VPH. METODOLOGÍA: Estudio retrospectivo efectuado mediante la búsqueda bibliográfica sistemática en la base de datos PubMed, sin restricción de fecha de publicación. Criterio de inclusión: ensayos clínicos aleatorizados (metanálisis y revisiones sistemáticas). Criterios de exclusión: ensayos clínicos en fase preclínica del desarrollo y publicaciones en idiomas distintos al inglés o español. RESULTADOS: Se seleccionaron 30 artículos publicados entre 2000 y 2020. Entre ellos, 5 ensayos clínicos aleatorizados con vacunas terapéuticas que ya han finalizado o aún están en estudio. Las 25 publicaciones restantes incluyen: metanálisis y revisiones sistemáticas de aspectos seleccionados con objetivos primarios y secundarios. CONCLUSIONES: Las vacunas terapéuticas contra VPH se encuentran en fase experimental; hasta ahora se han conseguido resultados prometedores con algunas de ellas. Si bien existen distintos tipos de vacunas terapéuticas, los mejores resultados se han conseguido con las basadas en ADN. Las vacunas VGX-3100 y TS, en fase III, han demostrado diferencias significativas en el aclaramiento viral y la regresión de las lesiones de alto grado en pacientes vacunadas. Una vacuna terapéutica efectiva tendría una repercusión inmediata en la morbilidad y mortalidad por lesiones asociadas al virus.

Abstract: OBJECTIVE: To assess the immunogenicity of different types of therapeutic vaccines and their effect on human papillomavirus (HPV) lesions after application. In addition, to analyze the safety studies and prospects of therapeutic HPV vaccines. METHODOLOGY: Retrospective study based on a systematic literature search of the PubMed database, with no publication date restrictions. Inclusion criteria: randomized clinical trials (meta-analyses and systematic reviews). Exclusion criteria: clinical trials in the pre-clinical phase of development and publications in languages other than English or Spanish. RESULTS: 30 articles published between 2000 and 2020 were selected. Among them, 5 randomized clinical trials with therapeutic vaccines that have already been completed or are still under study. The remaining 25 publications include: meta-analyses and systematic reviews of selected aspects with primary and secondary objectives. CONCLUSIONS: Therapeutic HPV vaccines are in the experimental phase; so far promising results have been achieved with some of them. Although different types of therapeutic vaccines exist, the best results have been achieved with DNA-based vaccines. The VGX-3100 and TS vaccines, in phase III, have demonstrated significant differences in viral clearance and regression of high-grade lesions in vaccinated patients. An effective therapeutic vaccine would have an immediate impact on morbidity and mortality from virus-associated lesions.

Issues on Current HPV Vaccination in Korea and Proposal Statement / 여성건강간호학회지

No abstract available.

A Text Mining Analysis of HPV Vaccination Research Trends

PURPOSE: The purpose of this study was to identify human papillomavirus (HPV) vaccination research trends by visualizing a keyword network.METHODS: Articles about HPV vaccination were retrieved from the PubMed and Web of Science databases. A total of 1,448 articles published in 2006~2016 were selected. Keywords from the abstracts of these articles were extracted using the text mining program WordStat and standardized for analysis. Sixty-four keywords out of 287 were finally chosen after pruning. Social network analysis using NetMiner was applied to analyze the whole keyword network and the betweenness centrality of the network.RESULTS: According to the results of the social network analysis, the central keywords with high betweenness centrality included “health education”, “health personnel”, “parents”, “uptake”, “knowledge”, and “health promotion”.CONCLUSION: To increase the uptake of HPV vaccination, health personnel should provide health education and vaccine promotion for parents and adolescents. Using social media, governmental organizations can offer accurate information that is easily accessible. School-based education will also be helpful.

Prevention and control of neoplasms associated with HPV in high-risk groups in Mexico City: The Condesa Study / Prevención y control de neoplasias asociadas a VPH en grupos de alto riesgo de la Ciudad de México: el Estudio Condesa

Abstract: Objective: To evaluate the effectiveness of a combined strategy of human papillomavirus virus (HPV) vaccination and high-risk HPV screening to reduce the occurrence of anogenital and oropharyngeal neoplasms among men who have sex with men, people with HIV, homeless people, transgender women, female sex workers and rape victims. Materials and methods: This mixed methods study evaluates the effectiveness of a combined vaccination-screening strategy to reduce HPV prevalence/incidence and occurrence of cervical intraepithelial neoplasms grade 2+ and/or anal intraepithelial neoplasms grade 2+, using Kaplan-Meier. The time-to-event method will evaluate time from positive results for specific anogenital HPV to incidence of anogenital lesions containing that HPV type. Results: People vaccinated against HPV and screened for HPV as a primary test will have lower prevalence and incidence of HPV infection and consequently lower frequency of HPV-related anogenital and oropharyngeal lesions. Conclusions: This study will generate scientific evidence on effectiveness of a combined vaccination-screening strategy to reduce the burden of HPV-associated neoplasms.

Resumen: Objetivo: Evaluar la efectividad de una estrategia combinada de vacunación contra el virus de papiloma humano (VPH) y tamizaje de VPH de alto riesgo para reducir neoplasias anogenitales y orofaringeas entre hombres que tienen sexo con hombres, personas con VIH, personas en situación de calle, mujeres transgénero, trabajadoras sexuales y víctimas de violación. Material y métodos: Este estudio evaluará la efectividad de una estrategia combinada de vacunación y tamizaje para reducir la ocurrencia de neoplasias intraepiteliales cervicales grado 2+ o neoplasias intraepiteliales anales grado NIA2+ utilizando Kaplan-Meier. Se evaluará tiempo de resultados positivos para tipos específicos de VPH anogenital a incidencia de lesiones anogenitales con ese tipo de VPH. Resultados: Las personas vacunadas contra VPH y con tamizaje de VPH tendrán menor prevalencia e incidencia de infecciones por VPH y por ende menor frecuencia de lesiones anogenitales y orofaringeas relacionadas con VPH. Conclusiones: Este estudio generará evidencia científica sobre la efectividad de una estrategia combinada de vacunación y tamizaje para reducir la carga de neoplasias asociadas al VPH.

Proposal for cervical cancer screening in the era of HPV vaccination

Eradication of cervical cancer involves the expansion of human papillomavirus (HPV) vaccine coverage and the development of efficient screening guidelines that take vaccination into account. In Korea, the HPV National Immunization Program was launched in 2016 and is expected to shift the prevalence of HPV genotypes in the country, among other effects. The experiences of another countries that implement national immunization programs should be applied to Korea. If HPV vaccines spread nationwide with broader coverage, after a few decades, cervical intraepithelial lesions or invasive cancer should become a rare disease, leading to a predictable decrease in the positive predictive value of cervical screening cytology. HPV testing is the primary screening tool for cervical cancer and has replaced traditional cytology-based guidelines. The current screening strategy in Korea does not differentiate women who have received complete vaccination from those who are unvaccinated. However, in the post-vaccination era, newly revised policies will be needed. We also discuss on how to increase the vaccination rate in adolescence.

Human Papillomavirus in Head and Neck Cancer: Several Questions / 대한이비인후과학회지

The past decade has seen changes in the global trends for head and neck cancers in terms of incidence, etiologic and demographic patterns. Several case-control studies have consistently shown human papillomavirus (HPV) exposure dramatically increases the occurrence of oropharyngeal cancer. HPV related (+) oropharyngeal cancer has been found to be epidemiologically and clinically distinctive disease, characterized by younger age at onset, and strong association with reproductive behavior. The incidence of this disease is increasing sharply worldwide, whilst HPV negative (-) cancers are declining. HPV(+) cancers have significantly better survival and responses to chemoradiation, than HPV(-) counterparts. Given this superior survival, de-escalated therapies and organ preservation surgeries are being considered and on the clinical trial. Currently available prophylactic virus-like particle vaccines might be efficacious for primary prevention of HPV(+) cancers, although not validated yet. More researches are needed for the effective secondary prevention, through the deeper understanding of precancerous, molecular and pathologic changes.

Epidemiology of cervical cancer in Colombia / Epidemiología del cáncer de cuello uterino en Colombia

Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000 and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infec¬tions in most populations. Most HPV exposures result in sponta¬neous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis. The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.

El cáncer de cérvix uterino es la tercera causa más frecuente de cáncer en el mundo y la primera o segunda más común en países en desarrollo. El cáncer de cérvix persiste en Colombia como la primera causa de mortalidad por cáncer en las mujeres, a pesar de la existencia de programa de tamización durante las últimas tres décadas. Bucaramanga, Manizales y Cali reportan tasas de incidencia alrededor de 20 por 100.000 y Pasto, 27 por 100.000. El Registro poblacional de cáncer de Cali ha reportado un descenso progresivo en las tasas de incidencia y mortalidad por cáncer de cérvix durante los últimos 40 años. Las razones para la declinación de las tasas de incidencia y mortalidad por cáncer de cérvix son múltiples y probablemente incluyen: mejoría en las condiciones socio-económicas, descenso en las tasas de fecundidad y algún efecto de los programas de tamización. El virus del papiloma humano (VPH) es la principal causa de cáncer de cuello uterino. Los estudios de la historia natural del VPH han revelado que el VPH es la infección de transmisión sexual más común en la mayoría de las poblaciones. La exposición a VPH resulta en una resolución espontánea sin manifestaciones clínicas y únicamente una pequeña fracción de las personas infectadas, conocida como portadores crónicos, retendrá el virus y progresará a lesiones precursoras y cáncer. Los genotipos de VPH 16 y 18 son responsables del 70% del cáncer de cérvix y los 8 tipos más comunes (VPH 16, 18, 45, 33, 31, 52, 58 and 35), se asocian con cerca del 90% de todos los casos de cáncer cervical. Los estudios de casos y controles también han permitido identificar los siguientes cofactores que actúan junto con la infección con VPH para aumentar el riesgo de cáncer de cérvix: tabaco, multiparidad, uso prolongado de contraceptivos orales y antecedentes de infecciones por virus del herpex simple tipo 2 y Clamidia trachomatis. La demostración de que la infección por ciertos tipos de virus del papiloma humano (VPH) no sólo es la causa principal, sino, también, una causa necesaria del cáncer cervical, ha conducido a grandes avances en la prevención de esta enfermedad en dos frentes: (i) La prevención primaria mediante el uso de vacunas profilácticas contra el VPH, y (ii) La prevención secundaria mediante el aumento de la precisión de la detección del cáncer de cuello uterino.

HPV Positivity and its’ Influencing Factors among Invasive Cervical Cancer Women in Malaysia

Cervical cancer (CC) is the second most prevalent female cancer in Malaysia. Almost 70% of its’ causal factors are attributable to oncogenic human papillomavirus (HPV) types 16, 18 and other risk factors. HPV genotypes distributions are also noted to differ by geographical area. This was cross sectional study conducted in 2007, to determine the influencing factors of HPV positivity and prevalence of HPV infections among patients with cervical cancer in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Patients’ paraffin-embedded cervical tissues kept in the Pathology Department from 1999 to 2007 were randomly selected. A total of 81 medical records with complete information were chosen as samples and patients were contacted for consent. Tissue samples were further derived for PCR DNA for HPV genotyping. Analyses included descriptive statistics; bivariate χ2 test and correlation were used to determine relationship between factors and HPV positivity. Significance level of less than 0.05 was taken as statistically significant. Mean age of cancer diagnosis was at 52 ± 12.2 years. Women of Chinese ethnicity was the highest ethnicity to be HPV positive at 65.4% and squamous cell carcinoma was more commonly found (59.3%) compared with other types of cancers. The prevalence of HPV positivity was 92.6% with type 16 being the most common (74.1%), followed by type 33 (30.9%) and 18 (22.2%). Multiple HPV infections were a common finding at 54.3%. Factors thought to influence positivity i.e. age of intercourse, number of sexual partners, number of parity, smoking status of patients and their partners, oral contraceptive usage, presence of chronic illnesses and cancer stage were not significantly associated with HPV positivity. Increased CC severity level was not associated with increased number of HPV infections (Pearson correlation 0.58; p =0.607). High HPV positivity at 92.6% was found among ICC patients. Factors thought to influence HPV positivity were not significant. The top three HPV genotypes were type 16 followed by type 33 and 18. However, local women HPV serotypes findings need to be replicated in a larger population sample.

Comparison of Factors Associated with Intention to Receive Human Papillomavirus Vaccine Between Male and Female Undergraduate Students / 여성건강간호학회지

PURPOSE: This study was done to identify and compare factors associated with intention to receive Human Papillomavirus (HPV) vaccine between male and female undergraduate students. METHODS: In the fall of 2010, 479 students responded to self-administered questionnaires about their intention to receive HPV vaccine, HPV knowledges, HPV related involvements and optimistic bias, subject's characteristics including opinion about HPV vaccine. Mann-Whitney U test, uni-variate and multi-variate logistic regression were used for data analysis with SPSS/WIN. RESULTS: Intention to receive vaccine were 22.0% of men and 25.0% of women. There were significantly different in HPV knowledge (Z=-2.74, p=.006), optimistic bias (Z=-4.60, p<.001), vaccine is necessary for women (Z=-4,30, p<.001), vaccine is necessary for men (Z=-4.37, p<.001), vaccine is necessary if only symptom exist (Z=-4.52, p<.001), but there were not different in intention to receive vaccine, involvement between men and women. Concern about vaccine safety (OR=3.19, 95% CI 1.63~6.23) was determinant of intention to receive HPV vaccine for men. CONCLUSION: This study showed gender differences in HPV knowledge, HPV related optimistic bias and opinion about HPV vaccine, which would be assessed and well managed in tailored HPV education for enhancing HPV vaccine acceptance.

Human papillomavirus vaccines: current issues & future.

Cervical cancer is the leading cause of cancer mortality among women in worldwide. Some 99 per cent of cervical cancer cases are linked to genital infection with human papillomaviruses (HPVs) comprised of approximately 15 oncogenic genital HPV types. Most HPV infections resolve spontaneously. But, the remainder persist and may then progress to cervical cancer in some women. In high-resource countries, the best way to prevent cervical cancer is to implement organised gynaecological screening programs with appropriate treatment of the detected pre-cancerous lesions. However, in developing countries, this method is not practicable because of cost and complexity of proper screening. Vaccines against HPV infections hold promise to reduce incidence of cervical cancer cost-effectively. Two Prophylactic HPV vaccines have been thus far developed: Gardasil, a quadrivalent vaccine targeting HPV-6, -11, -16 and -18) and Cervarix, a bivalent vaccine which targets HPV-16 and -18. Both vaccines contain L1 virus-like particles (VLPs) derived from HPV-16 and -18 which are most frequently associated with cervical cancer. The L1-VLP vaccines are HPV type-specific and therefore can effectively prevent infection of a HPV type in question alone. Therefore, the L1-VLP vaccines are hoped to be multivalent for 15 oncogenic HPV types, which comes at a price. Otherwise, costly cytologic screening for cervical cancer is still necessary. The current HPV vaccines thus may not be ultimate strategy and study on new HPV vaccines is needed. Broad-spectrum prophylactic vaccines against all oncogenic HPV types and therapeutic vaccines for clearance of HPV-related cervical lesion are being developed.