Comparación de protocolos de vacunación contra el virus del papiloma humano en Ecuador y América Latina / Comparation of vaccination protocols against the human papillomavirus in Ecuador and Latin America

INTRODUCCIÓN: El virus del papiloma humano (VPH), con más de 100 tipos, es de transmisión sexual. Varios países de América Latina han introducido las vacunas contra el VPH. Aunque América Latina es la región que más rápido avanzó en la vacunación contra el VPH, sus sistemas de seguimiento y vigilancia son aún deficientes. OBJETIVO: Comparar las diferentes estrategias de vacunación contra el VPH en Ecuador y América Latina. MÉTODO: Revisión bibliográfica, en la que se obtuvo información de documentos gubernamentales y artículos indexados en los últimos 5 años sobre las estrategias de vacunación contra el VPH en Ecuador y América Latina. RESULTADOS: La mayoría de los países de América Latina han logrado introducir la vacuna contra el VPH, excepto Venezuela, Martinica, Haití, Nicaragua y Cuba. CONCLUSIONES: Los protocolos de vacunación de Ecuador y América Latina necesitan mejorar sus sistemas de seguimiento y aumentar la expansión de datos de cobertura disponibles de manera consistente. Actualmente siguen existiendo desafíos para introducir las vacunas, lograr una alta cobertura y fortalecer el seguimiento, la evaluación y la notificación.

INTRODUCTION: The human papilloma virus (HPV), with more than 100 types, is a sexual transmission infection. Many Latin American countries have introduced the vaccines against the HPV. Although Latin América is the region which advanced faster against the HPV, its surveillance and follow-up systems are yet deficient. OBJECTIVE: To compare the different strategies to assume the vaccination against the HPV in Ecuador and Latin America. METHOD: Bibliographic review, in which information was obtained from government documents and articles indexed in the last five years on vaccination strategies against HPV in Ecuador and Latin America. RESULTS: Most Latin American countries have managed to introduce the vaccine against the HPV, except Venezuela, Martinica, Haiti, Nicaragua and Cuba. CONCLUSIONS: The vaccination protocols of Ecuador and Latin América need to improve their systems of follow-up and monitoring, and increase the expansion of available data in a consistent manner. Now, there are still existing challenges to introduce the vaccines, manage a high reach and fortify the follow-up, the evaluation, and the notification.

Papiloma Conjuntival: revisión bibliográfica / Conjunctival Papilloma: a literature review

Objetivo: El objetivo de la realización del presente artículo de revisión bibliográfica es analizar las características del Papiloma conjuntival como: el pronóstico, prevalencia, relación con el VPH, diagnóstico, tratamiento e importancia que representa la presencia del mismo. Métodos: El siguiente artículo se realizó mediante la búsqueda de artículos científicos en español e inglés, mismos que fueron obtenidos a través de base de datos como Scopus, PubMed y Google Academic. Se hizo usó de la plataforma virtual de la biblioteca católica de Cuenca utilizando comandos de búsqueda avanzada (""), AND, OR. Finalmente se incluyeron 15 artículos dentro de la revisión bibliográfica. Para el trabajo conjunto de los colaboradores se hizo uso de la plataforma Google Drive. Resultados: Papiloma conjuntival es un tumor de células escamosas benigno de la conjuntiva con una tendencia mínima a la malignidad. Estos tumores están relacionados con el VPH específicamente los tipos VI y XI. Para obtener un diagnóstico es importante realizar una anamnesis y un examen oftalmológico exhaustivo, una biopsia posterior a la extirpación de la lesión, la tomografía de coherencia óptica de alta definición (HR-OCT), y la biomicroscopia ultrasónica (UBM). El MSP, ha elaborado una iniciativa denominada "Programa Ampliado de Inmunizaciones (PAI)", mismo que consiste en el proceso de vacunación de la población femenina de 9, 10 y 11 años pertenecientes a escuelas públicas y privadas. Conclusiones: Es importante que las instituciones educativas fomenten más la salud ocular porque al momento de que existe un contagio de VPH hay riesgo de tener papiloma conjuntival y las personas desconocen este medio de transmisión. Además, se debe promover la vacunación en niños porque cualquier género es propenso a adquirir el VPH

Objective: The aim of this literature review article is to analyze the characteristics of: conjunctival papilloma such as prognosis, prevalence, relationship with HPV, diagnosis, treatment and importance of its presence. Methods: The following article was carried out by searching scientific articles in Spanish and English, which were obtained through databases such as Scopus, PubMed and Google Academic. We used the virtual platform of the Catholic Library of Cuenca using advanced search commands (""), AND, OR. Finally, 15 articles were included in the biliographic review. For the joint work of the collaborators, use was made of the Google Drive platform. Results: Conjunctival papilloma is a benign squamous cell tumor of the conjunctiva with a minimal tendency to malignancy. These tumors are related to HPV specifically types VI and XI. To obtain a diagnosis it is important to perform a thorough anamnesis and ophthalmologic examination, a biopsy after removal of the lesion, high-definition optical coherence tomography (HR-OCT), and ultrasonic biomicroscopy (UBM). The MSP has developed an initiative called "Expanded Program of Immunizations (PAI)", same that consists of the vaccination process of the female population of 9, 10 and 11 years old belonging to public and private schools. Conclusions: It is important that educational institutions promote more eye health because when there is an HPV infection there is a risk of having conjunctival papilloma and people are unaware of this means of transmission. In addition, vaccination should be promoted in children because any gender is prone to acquire HPV.

Epidemiological surveillance of Human Papillomavirus (HPV) genotypes in oral and genital tracts and the impact of HPV vaccination on male university students from Rio de Janeiro state, Brazil / Vigilância Epidemiológica dos genótipos de papilomavírus humano (HPV) nos tratos oral e genital e o impacto da vacinação em estudantes universitários do sexo masculino do estado do Rio de Janeiro, Brasil

Introduction: Human Papillomavirus (HPV) infections are of significant concern in men, given its potential impact on their health and the risk of transmission to partners. Understanding and addressing this infection in men is crucial to evaluate the effectiveness of vaccination in reducing HPV-related diseases. Objective: To assess the impact of HPV vaccination, potential genotype shifts, and adverse effects, through a prospective study conducted with male university students. Methods:The study involved 286 volunteers who were examined at Sexually Transmitted Disease Clinics at the Universidade Federal Fluminense in Niterói, Rio de Janeiro, Brazil. The HPV prevalence was evaluated using generic PCR, genotyped by DNA microarray and monitored adverse effects. Results: The findings of this study revealed the absence of moderate or severe adverse effects. Genetic shifts were observed, including the disappearance of oncogenic HPV types 16 and 18. Surprisingly, even after completing the full vaccine regimen, students still harbored HPV11 in the oral tract. Furthermore, persistent HPV 6 and 11 infections were identified in three students, who had pre-existing infections prior to vaccination, at the follow-up visit. Multivariate analysis uncovered independent associations, notably an increased risk of HPV infection in the oral tract among men who have sex with men. HPV prevalence rates remained low both before and after the vaccination scheme (T0: 14.7%, T1: 8.7%). Even after the full vaccination scheme, the prevalence remained similar at T2 (14.6%), with no statistically significant differences recorded. HPV11 emerged as the most prevalent type throughout the study, followed by HPV6. Vaccine genotypes were detected in a significant proportion of samples at T0 (85.4%), T1 (89.5%), and T2 (100%). Conclusion: Overall, this study suggests that vaccination may represent a promising approach to reducing HPV-related health risks. These findings shed light on the potential benefits and challenges of HPV vaccination, emphasizing the need for continued monitoring and vaccination efforts

Introdução: As infecções por papilomavírus humano (HPV) são de grande preocupação em homens, dada sua possível influência na saúde deles e no risco de transmissão para parceiros. Compreender e abordar essa infecção em homens é fundamental para avaliar a eficácia da vacinação na redução de doenças relacionadas ao HPV. Objetivo: Avaliar o impacto da vacinação contra o HPV, possíveis alterações genotípicas e efeitos adversos, por meio de um estudo prospectivo realizado em estudantes universitários do sexo masculino. Métodos: O estudo envolveu 286 voluntários examinados em Clínicas de Doenças Sexualmente Transmissíveis na Universidade Federal Fluminense, em Niterói, Rio de Janeiro, Brasil. A prevalência do HPV foi avaliada por polymerase chain reaction (PCR) genérico e genotipada por microarranjo de DNA, e foram monitorados os efeitos adversos. Resultados: Os resultados deste estudo revelaram a ausência de efeitos adversos moderados ou graves. Observaram-se mudanças genéticas, incluindo o desaparecimento dos tipos oncogênicos do HPV 16 e 18. Surpreendentemente, mesmo após a conclusão do esquema completo de vacinação, os estudantes ainda abrigavam o HPV 11 na cavidade oral. Além disso, foram identificadas infecções persistentes pelo HPV 6 e 11 em três estudantes que já tinham infecções preexistentes antes da vacinação e na visita de acompanhamento. A análise multivariada revelou associações independentes, especialmente um aumento no risco de infecção pelo HPV na cavidade oral em homens que têm relações sexuais com homens. As taxas de prevalência do HPV permaneceram baixas tanto antes quanto depois do esquema de vacinação (T0: 14,7%, T1: 8,7%). Mesmo após a conclusão do esquema de vacinação, a prevalência permaneceu semelhante em T2 (14,6%), sem diferenças estatisticamente significativas registradas. O HPV 11 emergiu como o tipo mais prevalente ao longo do estudo, seguido pelo HPV 6. Genótipos da vacina foram detectados em uma proporção significativa de amostras em T0 (85,4%), T1 (89,5%) e T2 (100%). Conclusão: No geral, este estudo sugere que a vacinação pode representar uma abordagem promissora para a redução dos riscos à saúde relacionados ao HPV. Esses achados lançam luz sobre os benefícios e desafios potenciais da vacinação contra o HPV, enfatizando a necessidade de monitoramento contínuo e esforços de vacinação

Expert consensus on the immunization strategy and practice of human papillomavirus vaccine for female adolescents in the Yangtze River Delta region / 中华预防医学杂志

Persistent infection of high-risk human papillomavirus (HPV) is the leading cause of cervical cancer. In order to achieve the goal of cervical cancer elimination, the World Health Organization (WHO) proposed the "90-70-90" goal, one of which is "90% of girls fully vaccinated with HPV vaccine by age 15 years". Based on the epidemiological characteristics of HPV infection and the characteristics of HPV vaccine, it is important to give priority to female adolescents to be vaccinated with HPV vaccine. CAV Affiliated Association for Standardized Management and Practice of Immunization Program organized an expert group to develop an expert consensus on the immunization strategy and practice of human papillomavirus vaccine for female adolescents in the Yangtze River Delta region. This consensus introduces HPV infection and related disease burden, safety, efficacy and effectiveness of HPV vaccination for female adolescents, factors affecting the health benefits of HPV vaccination for female adolescents, current HPV vaccination strategies for female adolescents, the expert advice, common problems and precautions in the Yangtze River Delta region. This consensus is developed to guide HPV vaccination for female adolescents in the Yangtze River Delta region and provide reference for other regions.

Infection of human papillomavirus and head and neck cancer / 中华肿瘤杂志

High-risk human papillomavirus (HPV)-related cancers consist of cervical cancer, anal cancer, penile cancer, vulvar cancer, vaginal cancer, and head and neck cancer (HNC). Of these, the disease burden of HNC is second only to cervical cancer. HNC mostly originates from malignant lesions of squamous epithelial cells and mainly includes oral cavity cancer, pharyngeal cancer (including nasopharyngeal cancer, oropharyngeal cancer, and hypopharyngeal cancer), and laryngeal cancer. Tobacco use, alcohol abuse, and HPV infection are three primary risk factors. Recently, there is an upward trend of HNC incidence globally, especially in high-income countries. In China, the disease burden and trends of HPV-related HNC are still not clear. A few small sample size and single-center studies suggest a high HPV prevalence and increasing trend in HNC. Methodological differences in HPV testing and regional variabilities still exist among these studies. Among the anatomic sites, oropharyngeal cancer has been shown to be caused by HPV infection, but the association of HPV with other sites is still under debate. In addition, there is a paucity of relevant studies. Here, this review narrates the association between HPV infection and HNC, compares the differences between global and Chinese studies, and then explores the importance of HPV infection in various anatomical sites. The main objective is to highlight the research on HPV-related HNC and promote relevant prevention and treatment programs.

Improved population coverage of the human papillomavirus vaccine after implementation of a school-based vaccination programme: the Singapore experience

INTRODUCTION@#Cervical cancer has a high disease burden in Singapore, and it is strongly associated with human papillomavirus (HPV) infections. Despite constant efforts to encourage vaccination, local HPV vaccine uptake remains low. Universal mass vaccination is a proven cost-effective method to reduce the cervical cancer disease burden. This paper reviews the newly implemented school-based HPV vaccination programme in Singapore and the factors that led to its success.@*METHODS@#Fully subsidised HPV vaccinations were offered to all Secondary 1 female students on an opt-in basis, starting as a rollout dose in 2019. One-time catchup vaccination was also offered to female students in Secondary 2-5. Eligible recipients were identified using enrolment data provided by Ministry of Education schools. A total of 19,144 students across 139 schools were offered the rollout dose, and 20,854 students across 140 schools were offered the catchup doses.@*RESULTS@#High vaccine uptake rates of 80.6%-87.3% were noted with the introduction of the school-based programme, translating to high vaccine coverage of 90.3%-93.4%. Only a small proportion of students (1.5%-1.9% per cohort) opted out. The rate of reported side effects, which were commonly known effects, was low at one in 1000. Among the students who reported side effects, those who received the second vaccine dose did so uneventfully.@*CONCLUSION@#High HPV vaccine coverage was achieved after implementation of the school-based immunisation programme. Timely assessment of knowledge lapses and targeted intervention, strong partnerships with stakeholders, constant on-site adaptation and positive social influence contributed to its success. This model can be applied to future school health programmes.

Importance of vaccination against human papillomavirus in a rural settlement in Terenos, Mato Grosso do Sul / Importância da vacinação contra o papilomavírus humano em um assentamento rural em Terenos, Mato Grosso do Sul

ABSTRACT OBJECTIVE To understand health professionals' perceptions about vaccination against human papillomavirus (HPV) in the Santa Mônica rural settlement in Terenos, Mato Grosso do Sul. METHODS Quantitative and qualitative methodologies, consultations on vaccination cards, records of community health agents and the focus group technique were used. The main factors of hesitation and vaccine refusal were analyzed, as well as the health team's strategies for the process of immunization against HPV, from June to August 2018. RESULTS Of 121 children and adolescents, 81 (66.94%) received the complete vaccination schedule. Complete vaccination coverage for women was 73.17% (60/82) and for men, 53.8% (21/39). It was observed that, although strategies are adopted for vaccine promotion, such as mobile actions, the public is resistant due to superficial knowledge about the vaccine and its use in an early age group, showing itself to be susceptible to the negative influence of the media and to society's taboos. In addition, difficulties regarding the use of the Unified Health System card and the shortage of professionals were also observed. CONCLUSION The results explain the immunization coverage below the target and reinforce the need to strengthen the family health strategy, as well as the permanent and continuing education of professionals, in order to increase parental confidence and adherence to vaccination.

RESUMO OBJETIVO Compreender as percepções dos profissionais de saúde acerca da vacinação contra o papilomavírus humano (HPV) no Complexo de assentamentos Santa Mônica, em Terenos, Mato Grosso do Sul. MÉTODOS Foram utilizadas metodologias quanti-qualitativas, consultas em cartões vacinais, registros de agente comunitários de saúde e a técnica de grupo focal. Foram analisados os principais fatores de hesitação e recusa vacinal, bem como as estratégias da equipe de saúde para o processo de imunização contra o HPV, de junho a agosto de 2018. RESULTADOS De 121 crianças e adolescentes, 81 (66,94%) receberam o esquema vacinal completo. A cobertura vacinal completa feminina foi de 73,17% (60/82) e a masculina de 53,8% (21/39). Observou-se que, embora sejam adotadas estratégias para a promoção da vacina, como ações volantes, o público encontra-se resistente devido ao conhecimento superficial sobre a vacina e sua utilização em faixa etária precoce, mostrando-se suscetível à influência negativa da mídia e aos tabus da sociedade. Além disso, dificuldades quanto ao uso do cartão do Sistema Único de Saúde e a escassez de profissionais também foram observadas. CONCLUSÃO Os resultados justificam a cobertura vacinal abaixo da meta e reforçam a necessidade de fortalecimento da estratégia de saúde da família, bem como da educação permanente e continuada dos profissionais, a fim de aumentar a confiança dos pais e a adesão à vacinação.

Papiloma humano según la percepción de estudiantes universitarios / Human papilloma according to the perception of university students

El objetivo del presente estudio fue determinar el conocimiento sobre el Virus del Papiloma Humano (VPH) en estudiantes universitarios de la ciudad de Guayaquil, Se realizó una investigación con alcance descriptivo y transaccional, con una población constituida por 3000 estudiantes universitarios, y una muestra probabilística de 332. La técnica empleada fué la encuesta y el instrumento de recolección de la información, un cuestionario con 15 preguntas. El conocimiento de esta enfermedad se determinó mediante una escala de valoración en las siguientes categorías: Insuficiente: de 1-3; Regular: 4-6; Bueno: 7-9; Muy Bueno; 10-12 y Excelente: 13-15. Se realizó la prueba de Kolmogorov- Smirnov para determinar la normalidad de la distribución de datos y la prueba del Chi-cuadrado para la comprobación de las hipótesis planteadas, los datos se procesaron con el paquete estadístico SPSS 21,0. Se concluye que existe una asociación significativa entre el grado de conocimiento del papiloma humano con la edad y el sexo de los estudiantes universitarios(AU)

The objective of the present study was to determine the knowledge about the Human Papilloma Virus (HPV) in university students in the city of Guayaquil. An investigation with a descriptive and cross-sectional scope was carried out, with a population made up of 3000 university students, and a probabilistic sample of 332. The technique used was the survey and the data collection instrument, a questionnaire with 15 questions. Knowledge of this disease was determined using an assessment scale in the following categories: Insufficient: 1-3; Regular: 4-6; Good: 7-9; Very good; 10-12 and Excellent: 13-15. The Kolmogorov-Smirnov test was performed to determine the normality of the data distribution and the Chi-square test to verify the hypotheses proposed, the data was processed with the SPSS 25.0 statistical package. It is concluded that there is a significant association between the degree of knowledge of the human papilloma with the age and sex of university students(AU)

Adesão e impacto da campanha de vacinação contra o vírus do papiloma humano (HPV) sobre a saúde da população feminina através de uma análise comparativa das regiões norte e sudeste do Brasil / Adherence and impact of the vaccination campaign against human papillomavirus (HPV) on the health of the female population by a comparative analysis of the north and southeast regions of Brazil

Introdução: O vírus do papiloma humano (HPV) é o quarto maior fator de mortalidade por câncer em mulheres no Brasil, e alvo da campanha de vacinação do SUS desde 2014. O estudo pretende expor os possíveis impactos da campanha, e compreender os motivos que influenciaram na adesão ao programa, a partir de uma comparação entre as Regiões Norte e Sudeste do Brasil.Métodos: Pesquisa elaborada entre os meses de janeiro de 2020 e setembro de 2021, analisando informações do banco de dados DATASUS-MS, comparando-se as Regiões Norte e Sudeste. As Regiões escolhidas basearam-se em dados de incidência de Câncer do colo do útero, assim como informações socioeconomicas que ressaltam as desigualdades encontradas no país.Resultados: A meta de vacinação para a campanha contra o HPV era de 80% (4,16 milhões) com esquema vacinal completo. Em 2014 observou-se queda na adesão entre as duas primeiras doses, de 57% (188.164/331.230) na Região Norte, e 73,5% (1.126.376/1.530.557) na Região Sudeste. Entre 2014 e 2018, houve aumento na realização de exames preventivos. O crescimento de exames entre meninas até 14 anos foi de 193% (933/318) no Norte, e 12,4% (3793/3374) no Sudeste.Conclusão: Ambas as Regiões não alcançaram a meta de cobertura vacinal. Em contrapartida, pode-se inferir um estímulo gerado pela campanha na busca pela saúde ginecológica. Destaca-se a necessidade da ampliação do alcance da saúde pública, e a abordagem da campanha de forma contextualizada a diferentes grupos sociais, garantindo a proteção de mais meninas e mulheres.

Introduction: Human papillomavirus (HPV) is the fourth leading factor in cancer mortality in women in Brazil and has been a target of the Brazilian Unified Health System (SUS for short, in Portuguese) vaccination campaigns since 2014. This study aimed to expose possible impacts of the campaigns and understand the reasons affecting adherence to the program by a comparative analysis of the North and Southeast regions of Brazil.Methods: The study was conducted between January 2020 and September 2021 and analyzed data from the DATASUS-MS database, comparing the North and Southeast regions of Brazil. These regions were chosen based on data on the incidence of cervical cancer, as well as on socioeconomic data that highlight inequalities within the country.Results: The HPV vaccination coverage target was 80% (4.16 million) with a complete vaccination schedule. In 2014, adherence between the first and second doses dropped by 57% (188.164/331.230) in the North region and 73.5% (1.126.376/1.530.557) in the Southeast region. From 2014 to 2018, the number of preventive gynecological examinations in girls up to 14 years of age increased by 193% (933/318) in the North region and 12.4% (3793/3374) in the Southeast region.Conclusion: Neither of the regions reached the vaccination coverage target. However, we can infer that the campaign encouraged individuals to seek gynecological care. It is necessary to extend the reach of public health care and to contextualize and tailor the campaign to the specific social groups, thus ensuring the protection of more girls and women.

Environmental factors associated with human papillomavirus vaccine coverage in adolescents: 2016-2020 analysis / Fatores ambientais associados à cobertura da vacina contra o papilomavírus humano em adolescentes: análise de 2016 a 2020 / Factores ambientales asociados con la cobertura de la vacuna contra el virus del papiloma humano en adolescentes: análisis de 2016 a 2020

Abstract Objective: to analyze the association between the factors of the social environment and the coverage rates of the human papillomavirus (HPV) vaccine in adolescents, in the State of Minas Gerais, Brazil. Method: this is an epidemiological, ecological study, with panel and trend analysis from 2016 to 2020. The population consisted of adolescents aged 9 to 13 years. The environmental variables were coverage rates, the municipal index of human development, income, education, and longevity; and the rate of violence. The Prais-Winsten autoregression and the panel regression model were used, in addition to the estimate of the mean annual percentage variation. Results: the vaccination coverage rates are below the goals recommended by the Ministry of Health for all regions analyzed. Moreover, these rates are associated with factors related to the application of the first dose and to aspects inherent to the social environment, such as the rate of violence. Conclusion: our findings showed that, although tenuous, aspects of the environment, in addition to individual characteristics, provide relevant information to understand the occurrence of health outcomes, since this vaccination campaign presents a strong influence of the environment and age as factors associated with the low rates.

Resumo Objetivo: analisar a associação entre os fatores do ambiente social e as taxas de cobertura da vacina contra o papilomavírus humano (HPV) nos adolescentes do estado de Minas Gerais. Método: estudo epidemiológico, ecológico, com análise em painel e de tendência, no período de 2016 a 2020. A população foi composta por adolescentes de 9 a 13 anos. As variáveis ambientais foram as taxas de cobertura; o índice de desenvolvimento humano municipal, de renda, de educação e de longevidade; e a taxa de violência. Utilizou-se o modelo autorregressivo de Prais-Winsten, o cálculo da variação percentual média anual e a regressão em painel. Resultados: as taxas de cobertura da vacina em todas as regiões analisadas estão abaixo das metas preconizadas pelo Ministério da Saúde. Ademais, tais taxas estão associadas aos fatores relacionados à aplicação da primeira dose e a aspectos inerentes ao ambiente social, como a taxa de violência. Conclusão: as evidências encontradas demonstraram que, embora tênues, aspectos do ambiente, além das características individuais, fornecem informações relevantes para compreensão da ocorrência dos desfechos de saúde, uma vez que para essa vacina temos a forte influência do ambiente e da idade como fatores associados à baixa taxa de vacinação.

Resumen Objetivo: analizar la asociación entre los factores del entorno social y las tasas de cobertura de la vacuna contra el virus del papiloma humano (VPH) en los adolescentes del estado de Minas Gerais. Método: estudio epidemiológico, ecológico, con análisis de panel y de tendencia, en el período de 2016 a 2020. La población estaba compuesta por adolescentes de 9 a 13 años. Las variables ambientales fueron las tasas de cobertura; el índice de desarrollo humano municipal, la renta, la educación y la longevidad, y la tasa de violencia. Se utilizó el modelo autorregresivo de Prais-Winsten, el cálculo de la variación porcentual media anual y la regresión en panel. Resultados: las tasas de cobertura de la vacuna en todas las regiones analizadas están por debajo de los objetivos recomendados por el Ministerio de Salud. Además, estas tasas están asociadas a los factores relacionados con la aplicación de la primera dosis y a aspectos inherentes al entorno social, como la tasa de violencia. Conclusión: las evidencias encontradas demostraron que, aunque tenues, aspectos del entorno, además de las características individuales, proporcionan informaciones relevantes para comprensión de la ocurrencia de los resultados de salud, una vez que para esa vacuna tenemos la fuerte influencia del entorno y de la edad como factores asociados a la baja tasa de vacunación.

Vaccination against human papillomavirus in Brazilian schoolchildren: National Survey of School Health, 2019 / Vacinação contra o papilomavírus humano em escolares brasileiros: Pesquisa Nacional de Saúde do Escolar, 2019 / Vacunación contra el virus del papiloma humano en escolares brasileños: Encuesta Nacional de Salud del Escolar, 2019

Abstract Objective: to analyze the prevalence of schoolchildren vaccinated against human papillomavirus (HPV) and the reasons related to non-vaccination. Method: cross-sectional study, with data from the 2019 National Survey of School Health. The sample consisted of 160,721 students aged 13 to 17 years. The prevalence and confidence intervals (95%CI) of vaccinated adolescents were estimated according to location, sex, and administrative dependence of the school. The differences between the strata were evaluated with the Chi-square test. Adjusted prevalence ratios (aPR) and 95%CI were estimated with the Poisson regression model. Results: most of the students were vaccinated (62.9%), and the prevalence of girls (76.1%) was higher than that of boys (49.1%). The most prevalent reason for not vaccinating was "did not know they had to take" (46.8%), with the highest aPR in public schoolchildren in Brazil (1.6; 95%CI 1.5;1.7), from the Northeast region (1.2; 95%CI 1.1;1.2), and in students from private schools in the Northeast regions (1.1; 95%CI 1.1;1.2) and North (1.3; 95%CI 1.2;1.4). Conclusion: one out of every two Brazilian schoolchildren was vaccinated against HPV. Misinformation was a recurring reason for non-vaccination. The North and Northeast regions had the highest prevalence of non-vaccinated people, observed mainly in adolescents from public schools.

Resumo Objetivo: analisar a prevalência de escolares vacinados contra o papilomavírus humano (HPV) e os motivos relacionados à não vacinação. Método: estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar de 2019. A amostra foi composta por 160.721 estudantes de 13 a 17 anos. Foram estimadas as prevalências e intervalos de confiança (IC95%) de adolescentes vacinados segundo localização, sexo e dependência administrativa da escola. Avaliaram-se as diferenças entre os estratos pelo teste Qui-quadrado. Estimaram-se as razões de prevalência ajustadas (RPa) e os IC95% pelo modelo de regressão de Poisson. Resultados: a maioria dos escolares foram vacinados (62,9%), sendo a prevalência de meninas (76,1%) superior à de meninos (49,1%). O motivo mais prevalente foi "não sabia que tinha que tomar" (46,8%), sendo as RPa mais elevadas em escolares de escolas públicas do Brasil (1,6; IC95% 1,5;1,7), da região Nordeste (1,2; IC95% 1,1;1,2) e em estudantes de escolas privadas das regiões Nordeste (1,1; IC95% 1,1;1,2) e Norte (1,3; IC95% 1,2;1,4). Conclusão: um a cada dois escolares brasileiros foi vacinado contra o HPV. A desinformação foi um motivo frequente para a não vacinação. As regiões Norte e Nordeste apresentaram as maiores prevalências de não vacinados, observadas principalmente em adolescentes de escolas públicas.

Resumen Objetivo: analizar la prevalencia de escolares vacunados contra el virus del papiloma humano (VPH) y las razones relacionadas con la no vacunación. Método: estudio transversal, con datos de la Encuesta Nacional de Salud del Escolar de 2019. La muestra estuvo compuesta por 160, 721 estudiantes de 13 a 17 años. Se estimaron las prevalencias e intervalos de confianza (IC95%) de adolescentes vacunados según ubicación, sexo y dependencia administrativa de la escuela. Las diferencias entre estratos se evaluaron mediante la prueba de Chi-cuadrado. Se estimaron las razones de prevalencia ajustadas (RPa) y los IC95% por el modelo de regresión de Poisson. Resultados: la mayoría de los escolares fueron vacunados (62,9%), siendo la prevalencia de niñas (76,1%) superior a la de los niños (49,1%). La razón más prevalente fue "no sabía que tenía que tomar" (46,8%), siendo las RPa más elevadas en escolares de escuelas públicas de Brasil (1,6; IC95% 1,5; 1,7), de la región Nordeste (1,2; IC95% 1,1; 1,2) y en estudiantes de escuelas privadas de las regiones de Nordeste (1,1; IC95% 1,1; 1,2) y Norte (1,3; IC95% 1,2; 1,4). Conclusión: uno de cada dos escolares brasileños ha sido vacunado contra el VPH. La desinformación fue una razón frecuente para la no vacunación. Las regiones Norte y Nordeste presentaron las mayores prevalencias de no vacunados, observadas principalmente en adolescentes de escuelas públicas.

Construção e validação de jogo educativo sobre a infecção pelo papilomavírus humano / Elaboración y validación de juego educativo sobre la infección por el virus del papiloma humano / Construction and validation of a serious game about human papillomavirus infection

Resumo Objetivo Descrever o processo de construção e validação de um jogo educativo para a prevenção da infecção causada pelo papilomavírus humano. Métodos Estudo metodológico que seguiu as etapas: conceituação, pré-produção, prototipagem, produção e avaliação de especialistas. Para a conceituação e pré-produção desenvolveu-se uma revisão integrativa, que gerou demandas de conhecimento, categorizadas e usadas na produção do protótipo. Na avaliação de especialistas, participaram 13 para análise do conteúdo e sete para design, que responderam instrumentos distintos. Os dados foram analisados quanto ao escore do Suitability Assessment of Materials e Índice de Validade de Conteúdo. Resultados Desenvolveu-se um jogo educativo baseado nas lacunas de conhecimento da população identificadas na literatura, denominado roleta digital. Os especialistas de conteúdo consideraram que a tecnologia desenvolvida possui potencial para a educação em saúde e prevenção das formas de adoecimento pelo papilomavírus humano. Na avaliação da aparência, os especialistas de design consideraram satisfatórios a compreensibilidade e qualidade da interface. Conclusão A roleta digital apresentou evidências de validade de conteúdo satisfatórias. As recomendações dos especialistas aprimoraram o conteúdo e aparência, possibilitando a mediação das atividades educativas.

Resumen Objetivo Describir el proceso de elaboración y validación de un juego educativo para la prevención de la infección causada por el virus del papiloma humano Métodos Estudio metodológico que siguió las siguientes etapas: conceptualización, preproducción, creación de prototipo, producción y evaluación de especialistas. Para la conceptualización y preproducción, se llevó a cabo una revisión integradora que generó demandas de conocimiento, que fueron categorizadas y utilizadas en la producción del prototipo. En la evaluación de especialistas, participaron 13 personas para el análisis de contenido y siete para el diseño, que respondieron distintos instrumentos. Los datos fueron analizados respecto a la puntuación del Suitability Assessment of Materials y del Índice de Validez de Contenido. Resultados Se desarrolló un juego educativo denominado ruleta digital, basado en los vacíos de conocimiento de la población identificados en la literatura. Los especialistas de contenido consideraron que la tecnología desarrollada posee potencial para la educación para la salud y la prevención de formas de contraer el virus del papiloma humano. En la evaluación de la apariencia, los especialistas en diseño consideraron satisfactorias la comprensibilidad y calidad de la interfaz. Conclusión La ruleta digital presentó evidencias de validez de contenido satisfactorias. Las recomendaciones de los especialistas mejoraron el contenido y la apariencia, lo que permitió la mediación de las actividades educativas.

Abstract Objective To describe the process of construction and validation of a serious game for the prevention of infection caused by human papillomavirus. Methods This is a methodological study that followed the steps: conceptualization, pre-production, prototyping, production and expert assessment. For conceptualization and pre-production, an integrative review was developed, which generated demands for knowledge, categorized and used in the prototype production. In an expert assessment, 13 participated for content analysis and seven for design, who answered different instruments. Data were analyzed for the score of Suitability Assessment of Materials and Content Validity Index. Results A serious game was developed based on gaps in population's knowledge identified in the literature, called electronic roulette. Content experts considered that the technology developed has potential for health education and prevention of forms of illness caused by the human papillomavirus. For assessing appearance, design experts found the understandability and quality of the interface satisfactory. Conclusion Electronic roulette presented satisfactory evidence of content validity. The recommendations of the experts improved the content and appearance, enabling the mediation of educational activities.

Knowledge, attitudes, and practices of adolescents regarding human papillomavirus / Conhecimentos, atitudes e práticas de adolescentes sobre o papilomavírus humano

ABSTRACT OBJECTIVE To analyze knowledge, attitudes, and practices of adolescent students from public schools in the municipality of Teresina, state of Piauí, regarding human papillomavirus (HPV). METHODS Cross-sectional, analytical study carried out in 12 public schools in the municipality of Teresina, with a random sample of 472 15-year-old adolescents. All participants answered a validated questionnaire, which evaluated sociodemographic characteristics, level of knowledge about HPV, attitudes regarding vaccination and vaccination status. The levels of knowledge and attitude were classified by standardized scores and practice by the vaccination situation. The analyses were carried out using the SPSS software. In the bivariate analysis, simple logistic regression was used generating odds ratios to identify the associations of sociodemographic characteristics, knowledge, and attitude with HPV prevention practice. Variables that presented p-value ≤ 0.20 in the bivariate analysis were inserted in a multivariate logistic regression model. Statistical significance was set at p < 0.05. RESULTS Among the participants, 27.3% had sufficient knowledge, 34.1% had positive attitudes, and 74.6% had adequate practice. In the multivariate analysis, we observed a statistically significant association among females (ORa = 15.62; 95%CI: 9.08-26.9), satisfactory knowledge (ORa = 2.09; 95%CI: 1.15-3.81), and positive attitudes (ORa = 1.89; 95%CI: 1.10-3.23) with proper practice. CONCLUSIONS Being female, having a satisfactory level of knowledge about HPV and the vaccine, and having positive attitudes towards HPV vaccination reinforce the appropriate practice of vaccination. These findings demonstrate the need to expand the knowledge of adolescents, generating positive attitudes towards vaccination within an appropriate perspective.

RESUMO OBJETIVO Analisar conhecimentos, atitudes e práticas de adolescentes estudantes de escolas públicas do município de Teresina-PI sobre o papilomavírus humano (HPV). MÉTODOS Estudo transversal, analítico, realizado em 12 escolas da rede pública do município de Teresina, com uma amostra aleatória de 472 adolescentes de 15 anos. Todos os participantes responderam a um questionário validado, que avaliou as características sociodemográficas, o nível de conhecimento sobre o HPV, atitudes relacionadas à vacinação e ao status vacinal. Os níveis de conhecimento e atitude foram classificados por meio de escores padronizados e a prática mediante a situação vacinal. As análises foram realizadas com o uso do SPSS. Na análise bivariada, utilizou-se a regressão logística simples, por meio de odds ratio para identificar as associações entre as características sociodemográficas e o conhecimento, e a atitude com a prática de prevenção contra o HPV. As variáveis que na análise bivariada apresentaram valor de p ≤ 0,20 foram submetidas ao modelo multivariado de regressão logística. A significância estatística foi fixada em p < 0,05. RESULTADOS Dentre os participantes, 27,3% apresentaram conhecimento suficiente, 34,1% atitudes positivas e 74,6% prática adequada. Na análise multivariada observou-se associação estatisticamente significativa entre o sexo feminino (ORa = 15,62; IC95%: 9,08-26,9), conhecimento satisfatório (ORa = 2,09; IC95%: 1,15-3,81), e atitudes positivas (ORa = 1,89; IC95%: 1,10-3,23) com a prática adequada. CONCLUSÕES Ser do sexo feminino, ter nível de conhecimento sobre o HPV e a vacina classificados como satisfatório, bem como ter atitudes positivas frente à vacinação contra o HPV reforçam a prática adequada de vacinação. Estes achados demonstram a necessidade de ampliar o conhecimento dos adolescentes, gerando atitudes positivas com vistas à vacinação dentro de uma perspectiva adequada.

Clinical research progress and implications of therapeutic vaccines for cervical cancer and precancerous lesions: a qualitative systematic review / 中华肿瘤杂志

Objective: To systematically summarize and analyze the clinical research progress of therapeutic vaccines for cervical cancer or precancerous lesions. Methods: English databases (PubMed, Embase, Web of Science, Cochrane library, Proquest, and ClinicalTrails.gov) and Chinese databases (SinoMed, CNKI, WanFang, and VIP Database) were systematically searched to collect literature on therapeutic vaccines for cervical cancer or precancerous lesions from inception to February 18, 2021. After screening, we evaluated the risk of bias of included studies, and combed the basic information of the literature, research designs, information of vaccines, study patients, outcome indicators and so on, qualitatively summarized the clinical research progress. Results: A total of 71 studies were included in this systematic review, including 14 random controlled trials, 15 quasi-random controlled trials, 4 cohort studies, 1 case-control study, 34 case series studies and 3 case reports. The study patients included women aged 15~79 with cervical cancer or precancerous lesions in 18 countries from 1989 to 2021. On the one hand, there were 40 studies on therapeutic vaccines for cervical precancerous lesions (22 867 participants), involving 21 kinds of vaccines in 6 categories. Results showed 3 marketed vaccines (Cervarix, Gardasil, Gardasil 9) as adjuvant immunotherapies were significant effective in preventing the recurrence of precancerous lesions compared with the conization only. In addition, MVA E2 vaccine had been in phase Ⅲ clinical trials as a specific therapeutic vaccine, with relative literature showing it could eliminate most high-grade precancerous lesions. Therapeutic vaccines for precancerous lesions all showed good safety. On the other hand, there were 31 studies on therapeutic vaccines for cervical cancer (781 participants), involving 19 kinds of vaccines in 7categories, with none had been marketed. 25 studies were with no control group, showing the vaccines could effectively eliminate solid tumors, prevent recurrence, and prolong the median survival time. However, the vaccines effectiveness couldn't be statistically calculated due to the lack of a control group. As for the safety of therapeutic vaccines for cervical cancer, 9 studies showed that patients experienced serious adverse events after treatments, where 7 studies reported that serious adverse events occurred in patients couldn't be ruled out as the results of therapeutic vaccines. Conclusions: The literature review shows that the literature evidence for the therapeutic vaccines for cervical precancerous lesions is relatively mature compared with the therapeutic vaccines for cervical cancer. The four kinds of vaccines on the market are all therapeutic vaccines for precancerous lesions, but they are generally used as vaginal infection treatments or adjuvant immunotherapies for cervical precancerous lesions, not used for the specific treatments of cervical precancerous lesions. Other specific therapeutic vaccines are in the early stage of clinical trials, mainly phase Ⅰ/Ⅱ clinical trials with small sample size. The effectiveness and safety data are limited, and further research is still needed.

Detección y control del cáncer de cuello uterino en mujeres de 35 a 44 años en Ecuador / Detection and control of cervical cancer in women aged 35 to 44 yearsin Ecuador

INTRODUCCIÓN: El cáncer de cuello uterino es un problema de salud pública que se origina en las células que recubren el cuello del útero, cuya etiología se relaciona frecuentemente con el virus del Papiloma Humano. Esta patología solo se presenta en las mujeres, siendo el segundo más común entre las tipologías de cáncer; su aparición puede ser prevenible mediante el control y la detección oportuna. OBJETIVO: Determinar el nivel de control y detección de cáncer cérvico-uterino que tienen las mujeres de 35 a 44 años. METODOLOGÍA: La investigación es cuantitativa, descriptiva y de corte transversal. La muestra fue de 267 mujeres de 35 a 44 años. Se aplicó una encuesta virtual de manera voluntaria y aleatoria a la población femenina de dichas edades, en la cual se establecieron preguntas categorizadas en: Conocimiento general, Control y Detección, éstas nos ayudarán a comprobar el grado de información, control y detección del cáncer cérvico-uterino que tenga dicha población. RESULTADOS: El porcentaje general varía de acuerdo a las categorías de las encuestas empleadas, a partir de las cuales se refleja que el 52,8% tiene conocimiento acerca de los métodos de control y detección del cáncer cérvico-uterino, el 44,3% no ha recibido información acerca del tema y, el 2,9% tiene un conocimiento incompleto. CONCLUSIÓN: El cáncer cérvico-uterino afecta con mayor frecuencia a las mujeres sexualmente activas dentro del rango de edad de 35 y 44 años, siendo la falta de información de la población femenina y la ausencia de controles sanitarios algunos de los factores que predisponen a una alta incidencia y prevalencia de la morbi ­mortalidad a causa de esta patología.

INTRODUCTION: Cervical cancer is a public health problem that originates in the cells lining the cervix, whose etiology is often associated with the Human Papillomavirus. This pathology only occurs in women, being the second most common among cancer typologies; its appearance can be preventable through control and timely detection. OBJECTIVE: To determine the level of control and detection of cervical-uterine cancer in women aged 35 to 44. METHODOLOGY: The research is quantitative, descriptive and cross-sectional. The sample was 267 women aged 35 to 44 years. A voluntary and random virtual survey was applied to the female population of these ages, in which questions categorized in: General knowledge, Control and Detection were established, these will help us to verify the degree of information, control and detection of cervical-uterine cancer in that population. RESULTS: The percentage varies according to the categories of surveys used, showing that 50.3 per cent have knowledge of methods for the control and detection of cervical-uterine cancer, 41.1 per cent have not received information on the subject and 8.6% have incomplete knowledge. CONCLUSIONS: Cervical-uterine cancer most often affects sexually active women in the 35-44 age range, The lack of information from the female population and the absence of health controls are some of the factors that predispose to a high incidence and prevalence of morbidity -mortality due to this pathology.

School-based HPV Vaccination: The Challenges in a Brazilian Initiative / Vacinação contra o HPV em base escolar: Os desafios de uma iniciativa brasileira

Abstract Objective The present study assesses the implementation and the impact after 2 years of a school-based human papillomavirus (HPV) vaccination program in a Brazilian city. Methods A prospective study assessing the implementation of the program, offering quadrivalent HPV vaccine in two annual doses to girls and boys aged from 9 to 10 years old. The program was started in the city of Indaiatuba, state of São Paulo, Brazil, in 2018, and had authorization from the National Immunization Program. The number of HPV vaccine first doses applied and the coverage in 2018 was calculated and compared to the year 2017. There were described events that have influenced the results. Results The program invited 4,878 children through schools (87.1% of the target population), and 7.5% refused vaccination. Several concurrent events required or competed for health professionals of the vaccination teams. The coverage of the first dose (between 9 and 10 years old) was 16.1% in 2017 and increased to 50.5% in 2018 (p < 0.0001). The first dose in all ages increased 78% in 2018 compared with 2017 (6,636/3,733). Competing demands over the program continued in 2019, and the first dose coverage dropped (26.9%). For 2020, a municipal law instituted school-based vaccination and the creation of dedicated teams for vaccination, and these strategies are waiting to be tested. Conclusion School-based annual HPV vaccination in children between 9 and 10 years old was feasible and increased vaccination coverage, regardless of gender, although the program was vulnerable to competing events.

Resumo Objetivo O presente estudo avalia a implantação de um programa de vacinação contra o papilomavírus humano (HPV) em escolas de uma cidade brasileira e o impacto após 2 anos. Métodos Estudo prospectivo para avaliar a implementação do programa, oferecendo a vacina quadrivalente contra o HPV em duas doses anuais, para meninas e meninos de 9 a 10 anos. O programa foi autorizado pelo Programa Nacional de Imunizações na cidade de Indaiatuba, estado de São Paulo, Brasil, e teve início em 2018. A cobertura anual da primeira dose foi comparada ao ano de 2017, e os eventos que influenciaram os resultados foram descritos. Resultados O programa convidou 4.878 crianças por meio das escolas (87,1% da população-alvo) e 7,5% recusou a vacinação. Vários eventos concorrentes exigiram ou competiram pelos profissionais de saúde das equipes de vacinação. A cobertura da primeira dose (9 a 10 anos) foi de 16,1% em 2017 e aumentou para 50,5% em 2018 (p < 0,0001). A primeira dose em todas as idades aumentou 78% em 2018 em comparação com 2017 (6.636/3.733). As demandas concorrentes sobre o programa continuaram em 2019, e a cobertura da primeira dose caiu (26,9%). Para 2020, uma lei municipal instituiu a vacinação nas escolas e a criação de equipes dedicadas à vacinação, e estas estratégias aguardam para ser testadas. Conclusão A vacinação anual contra o HPV em base escolar nas idades de 9 a 10 anos foi viável e aumentou a cobertura vacinal, independentemente do gênero, embora o programa fosse vulnerável a eventos concorrentes.

Desconhecimento sobre a campanha de vacinação contra o HPV entre estudantes brasileiros: uma análise multinível / Lack of awareness of the HPV vaccination campaign among Brazilian students: a multilevel analysis

Resumo O objetivo deste artigo é analisar a associação entre o desconhecimento sobre a campanha de vacinação contra o HPV entre adolescentes e fatores individuais e contextuais. Estudo transversal com dados da Pesquisa Nacional de Saúde do Escolar (2015). Foi realizada a análise bivariada e calculadas as Razões de Prevalência em uma Regressão de Poisson multinível (IC95%) para verificar o efeito das variáveis no desfecho. O desfecho esteve associado significativamente a ter 15-19 anos de idade (RP=1,36), estudar no turno da tarde/noite (RP=1,05), já ter tido relações sexuais (RP=1,10), com autopercepção do estado de saúde ruim ou muito ruim (RP=1,23), insatisfeito (RP=1,14) ou indiferente (RP=1,15) à sua imagem corporal, que falta às aulas sem consentimento dos pais (RP=1,10) e que estuda em escola pública (RP=1,24). Houve menor prevalência do desfecho entre o sexo feminino (RP=0,24) e em estados com maior desigualdade de renda (RP=0,80). O desconhecimento sobre a campanha de vacinação contra o HPV entre adolescentes foi associado às características individuais e do contexto da escola e da unidade de federação. Esses achados indicam a importância de fortalecer a promoção à saúde voltada aos jovens em vulnerabilidade.

Abstract The scope of this article is to analyze the association between lack of awareness of the HPV vaccination campaign among Brazilian adolescents and individual and contextual factors. It involved a cross-sectional study with data from the National Student Health Survey (2015). Bivariate analysis was performed and Prevalence Ratios were calculated, in a multilevel Poisson Regression (95%CI) to verify the effect of variables on the outcome. The outcome was significantly associated with being 15-19 years old (PR=1.36), studying during the afternoon/night shift (PR=1.05), having already had sexual intercourse (PR=1.10), with self-perceived poor or very poor health status (PR=1.23), dissatisfied (PR=1.14) or indifferent (PR=1.15) regarding their body image, playing truant from classes without parental consent (PR=1.10) and studying at a public school (PR=1.24). There was less prevalence of the outcome among females (PR=0.24) and in states with greater income inequality (PR=0.80). The lack of awareness about the HPV vaccination campaign among adolescents was associated with individual characteristics, the context of the school and the unit of the federation. These findings indicate the importance of enhancing health promotion for vulnerable young people.

Implementación del diagnóstico molecular del VPH: experiencia chilena en curso / Molecular diagnosis of human papillomavirus infection: the Chilean experience

Cervical Cancer (CaCu) has a heterogeneous epidemiological behavior throughout the planet, depending on regional socioeconomic development level. Some developed countries predict a potential eradication of this cancer in the next 100 years, while in Chile it still constitutes a pending challenge. Incidence rates show a slow but sustained downward prob, however, mortality has continued to fluctuate between 500-600 cases per year. A few years ago, vaccination against Human Papillomavirus (HPV), the main causal agent for this tumor, was consolidated as a public policy, both in girls and in boys. However, the technological leap in the screening prob was pending, from cytology to molecular diagnosis of the agent (HPV). In this report, we update our most recent data (2018) regarding CaCu mortality, then review global guidelines and experiences in HPV screening. Finally, we offer an account of the strategies that our health system is promoting to address the screening of the disease and whose molecular approach generates the widest worldwide scientific consensus. We also recognize the main barriers and future challenges, which, if overcome, would allow us to be in line with the mandate of WHO to control this women's health problema.