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.

Conhecimento de acadêmicos de enfermagem sobre a vacina contra o papilomavírus humano / Conocimientos de académicos de enfermería sobre la vacuna contra el virus del papiloma humano / Nursing students' knowledge on the human papillomavirus vaccine

Resumo Objetivo Avaliar o conhecimento entre acadêmicos de enfermagem sobre a vacina contra o papilomavírus humano e comparar os resultados obtidos entre estudantes do primeiro e do último ano de graduação. Métodos Estudo descritivo, transversal, quantitativo, realizado entre maio e junho de 2019. Aplicado questionário a 179 estudantes do curso de Enfermagem de uma universidade pública do estado de São Paulo, contendo dados sociodemográficos e outro sobre o conhecimento do papilomavírus humano e a vacina contra o mesmo. Dados foram analisados através do programa Statistical Packcage for Social Science. Resultados 82,4% dos estudantes do primeiro ano e 95,5% do último responderam que sabiam o que é o papilomavírus humano, e afirmaram ser um vírus sexualmente transmissível. Lacunas de conhecimento foram identificadas, quanto à finalidade do exame citopatológico, aos fatores de risco relacionados à infecção e relacionados à vacina, como número de doses e possíveis riscos e benefícios da mesma. Conclusão Apesar de os acadêmicos demonstrarem conhecimento quanto ao papilomavírus humano, sua transmissibilidade e relação direta com o câncer do colo do útero, ainda apresentaram dúvidas importantes que devem ser sanadas, quanto à finalidade do exame citopatológico, aos fatores de risco para infecção pelo vírus e em relação à vacina contra o papilomavírus humano.

Resumen Objetivo Evaluar los conocimientos de académicos de enfermería sobre la vacuna contra el virus del papiloma humano y comparar los resultados obtenidos de estudiantes del primer y del último año de carrera. Métodos Estudio descriptivo, transversal, cuantitativo realizado entre mayo y junio de 2019. Cuestionario aplicado a 179 estudiantes de la carrera de Enfermería de una universidad pública del estado de São Paulo, que contenía datos sociodemográficos, y otro sobre conocimientos del virus del papiloma humano y su vacuna. Los datos fueron analizados a través del programa Statistical Packcage for Social Science. Resultados El 82,4 % de los estudiantes de primer año y el 95,5 % del último respondieron que sabían lo que es el virus del papiloma humano y afirmaron que es un virus sexualmente transmisible. Se identificaron vacíos de conocimiento respecto a la finalidad del estudio citológico, a los factores de riesgo relacionados con la infección y con la vacuna, como número de dosis y sus posibles riesgos y beneficios. Conclusión A pesar de que los académicos demostraron conocimientos respecto al virus del papiloma humano, su transmisión y relación directa con el cáncer de cuello uterino, también presentaron dudas importantes que deben ser aclaradas sobre la finalidad del estudio citológico, los factores de riesgo de la infección por el virus y sobre la vacuna contra el virus del papiloma humano.

Abstract Objective To assess nursing students' knowledge on the human papillomavirus vaccine and compare the results obtained among students of the first and last year of graduation. Methods This is a descriptive, cross-sectional, quantitative study, conducted between May and June 2019. A questionnaire was applied to 179 nursing students from a public university in the state of São Paulo, containing sociodemographic data and another on knowledge of human papillomavirus and the vaccine against it. Data were analyzed using the Statistical Packcage for Social Science. Results 82.4% of first-year students and 95.5% of last-year students answered that they knew what human papillomavirus is, claiming to be a sexually transmitted virus. Knowledge gaps were identified regarding the purpose of cytopathological examination, risk factors related to infection and related to the vaccine, such as number of doses and possible risks and benefits of it. Conclusion Although students demonstrated knowledge on human papillomavirus, its transmissibility and direct relationship with cervical cancer, they still presented important doubts that should be answered, regarding the purpose of the cytopathological examination, the risk factors for infection by the virus and in relation to the vaccine against the human papillomavirus.

O conhecimento dos profissionais de saúde sobre vacinação de pessoas vivendo com HIV - uma revisão integrativa / El conocimiento de los profesionales de la salud sobre la vacunación de personas que viven con VIH - revisión integradora / Health professionals' knowledge about vaccination of people living with HIV - an integrative review

Resumo Objetivo Identificar evidências na literatura acerca do conhecimento dos profissionais de saúde sobre vacinação das pessoas vivendo com HIV. Método Trata-se de uma revisão integrativa. Para a busca, foram utilizados os descritores: pessoal de saúde (health personnel), conhecimento (knowledge), vacinação (vaccination), HIV e seus sinônimos, sem utilização de filtros, nas bases de dados Pubmed, Biblioteca Virtual em Saúde, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct e Cochrane. Foram incluídos apenas artigos primários analisados por meio do aplicativo RAYYAN. Resultados De 601 publicações iniciais, apenas cinco constituíram a amostra final, todas identificadas no Pubmed publicadas entre 2013 e 2018, sendo nenhum estudo brasileiro. A maioria das publicações estava relacionada a alguma vacina específica e não abordava todo o calendário vacinal. Conclusão e implicações para a prática O déficit de conhecimento dos profissionais de saúde, em relação às vacinas indicadas às pessoas vivendo com HIV, foi o principal aspecto identificado, resultando em insegurança dos profissionais. Há a necessidade de educação permanente das equipes multiprofissionais dos serviços especializados e da atenção primária visando diminuir as barreiras e aumentar a cobertura vacinal desta clientela.

Resumen Objetivo Identificar evidencias en la literatura acerca del conocimiento de los profesionales de la salud sobre la vacunación de personas que viven con VIH. Método Revisión integradora. Para la búsqueda, se utilizaron los descriptores: personal de salud (health personnel), conocimiento (knowledge), vacunación (vaccination), VIH y sus sinónimos, sin el uso de filtros, en las bases de datos Pubmed, Biblioteca Virtual en Salud, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct y Cochrane. Solo se incluyeron los artículos primarios analizados mediante la aplicación RAYYAN. Resultados De 601 publicaciones iniciales, solo cinco constituyeron la muestra final, todas identificadas en Pubmed y publicadas entre 2013 y 2018, sin ningún estudio brasileño. La mayoría de las publicaciones estaban relacionadas con una vacuna específica y no abordaban todo el calendario de vacunación. Conclusión e implicaciones para la práctica El desconocimiento de los profesionales de la salud en relación a las vacunas indicadas para personas que viven con VIH fue el principal aspecto identificado, lo que generó inseguridad entre los profesionales. Se advierte la necesidad de disponer la educación permanente de los equipos multiprofesionales de servicios especializados y de atención primaria para reducir barreras y aumentar las coberturas de vacunación de esta clientela.

Abstract Objective to identify evidence in the literature about the health professionals' knowledge concerning vaccination of people living with HIV. Method This is an integrative review. In this research, the descriptors used were the following: health personnel, knowledge, vaccination, HIV and its synonyms, without the use of filters, in the Pubmed, Virtual Health Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct and Cochrane databases. Only primary articles analyzed using the RAYYAN application were included. Results Out of 601 initial publications, only five comprised the final sample, all identified in Pubmed and published between 2013 and 2018, with no Brazilian studies. Most of the publications were related to a specific vaccine and did not address the entire vaccination schedule. Conclusion and implications for the practice The health professionals' lack of knowledge in relation to vaccines indicated to people living with HIV was the main aspect identified, resulting in insecurity among the professionals. There is a need for permanent education of the multidisciplinary teams of specialized services and primary care in order to reduce barriers and to increase vaccination coverage for this clientele.

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.

Understanding of Human Papilloma Virus Vaccine Receipt among Adolescents in Trinidad and Tobago / Comprensión del Recibo de la Vacuna Contra el VPH entre los Adolescentes en Trinidad y Tobago

ABSTRACT Objective: To understand the barriers or factors that may hinder receipt of the human papilloma virus (HPV) among adolescent girls, 14-18 years old, and evaluate the awareness level about HPV and the HPV vaccine acceptance. Methods: A questionnaire consisting of two parts, demographic and family history of cervical cancer, and a cluster of questions about HPV, was distributed to 651 female adolescents in 17 secondary schools in Trinidad and Tobago to determine knowledge, attitude, and awareness levels pertaining to HPV and acceptance of the HPV vaccine. Chi-square tests and logistic regressions were used. Results: Of the 651 students completing questionnaires, the majority (61%) were in the 15-16 age group; and 76% were either of African descent or multi-racial. There were significant associations between a family member having a diagnosis of cervical cancer and knowledge that cervical cancer is caused by the HPV virus, that the virus is spread sexually, and the likelihood of getting cervical cancer in the future (p = < 0.05). However, the majority (63%) did not know that cervical cancer is caused by the HPV virus or that the virus was spread sexually. Conclusion: Lack of knowledge of the HPV vaccine was seen among adolescents from each school. There is need for education on cervical cancer and its causes, and the HPV virus.

RESUMEN Objetivo: Entender las barreras o factores que pueden obstaculizar la recepción del virus del papiloma humano (VPH) entre las adolescentes, de 14-18 años, y evaluar el nivel de concientización sobre el VPH y la aceptación de la vacuna contra el VPH. Métodos: Un cuestionario de dos partes -antecedentes demográficos e historia familiar de cáncer cervicouterino--, y un grupo de preguntas sobre el VPH, fueron distribuidos entre 651 adolescentes femeninas en 17 escuelas secundarias de Trinidad y Tobago para determinar los niveles de conocimiento, actitud y concientización relacionados con el VPH y la aceptación de la vacuna contra el VPH. Se utilizaron pruebas de Chi-cuadrada y regresiones logísticas. Resultados: De las 651 estudiantes que respondieron los cuestionarios, la mayoría (61%) estaban en el grupo de edad de 15-16 años; y el 76% eran de ascendencia africana o multirracial. Hubo asociaciones significativas entre un miembro de la familia con diagnóstico de cáncer cervical y el conocimiento de que el cáncer cervical es causado por el virus del VPH, que el virus se propaga sexualmente, y que existe la probabilidad de contraer cáncer cervical en el futuro (p = < 0.05). Sin embargo, la mayoría (63%) no sabía que ese tipo de cáncer es causado por el virus VPH, ni que el virus se propaga sexualmente. Conclusión: Se observó falta de conocimiento de la vacuna contra el VPH entre las adolescentes de cada escuela. Hay necesidad de educación sobre el cáncer cervical y sus causas, y el virus del VPH.

Infección genital masculina por virus de papiloma humano / Male genital infection by human papiloma virus

El virus del papiloma humano (VPH) es una de las enfermedades de transmisión sexual más comunes. Puede afectar tanto el aparato genital masculino y femenino, como también el área perianal, ano, y diversas áreas de cabeza y cuello y otorrinolaringológicas, ya sea como lesiones benignas o como promotor de lesiones malignas. Las lesiones benignas por VPH en genitales masculinos se caracterizan fundamentalmente por la aparición de lesiones verrugosas, aunque también puede manifestarse mediante lesiones planas atípicas. En algunos casos hay ausencia de lesiones macroscópicamente visibles que pueden hacerse evidentes con la prueba de ácido acético. La biopsia de la lesión, su evaluación anatomopatológica y, sobre todo, la determinación de la existencia y el tipo de virus involucrado mediante PCR (reacción en cadena de la polimerasa) permiten confirmar el diagnóstico. En algunas ocasiones es necesario realizar una cistoscopia para diagnosticar lesiones intrauretrales y vesicales. Los tratamientos propuestos son muy variados y de eficacia dispar, desde las topicaciones y la electrocirugía o la criocirugía, hasta el empleo de la tecnología láser. La prevención con el uso de protección durante el acto sexual así como la educación sexual son fundamentales. En los últimos 10 años se ha implementado el uso de la vacuna para el VPH en niñas con el fin de disminuir la incidencia de lesiones de alto grado y de cáncer de cuello uterino, pero su indicación en varones es menos clara y aún no ha sido consensuada. (AU)

Human papiloma virus (HPV) is one of the most common sexual transmitted diseases. It can affect the male genitalia, as well as the perianal and anal regions and multiple areas of the head and neck and otorhinolaryngological structures, as benign lesiones or as a promoter of malignant lesions. Benign male genitalia lesions are characterized mainly by verrucous lesions, although flat atypical lesions can be found, as well as the abscence of macroscopic visible lesions that in some cases can become evident using the acetic acid test. Lesion biopsy, its histological evaluation, and the determination of the existence and type of virus using PCR (Polymerase Chain Reaction) can confirm the diagnosis. In some cases is necessary to do a cistoscopy to diagnose intraurethral and vesical lesions. Proposed treatments are varied and with a wide range of efficacy, from topications to electro or cryosurgery, and the use of laser technology. Sexual education and the use of sexual protection are essential in prevention. In the last 10 years the use of VPH vaccine in girls was widely spread, in order to decrease the incidence of high grade lesions and cervix cancer. Its indication in male patients is less clear and not yet consented among specialists. (AU)

Aceptación de la vacuna contra el virus del papiloma humano y los factores asociados en la ciudad de Resistencia, Chaco / Acceptance of human papillomavirus vaccination and associated factors in the city of Resistencia, Argentina

Introducción. En Argentina, se diagnostican 3000 nuevos casos y más de 2000 muertes por cáncer de cuello uterino cada año. El virus del papiloma humano es el principal factor de riesgo en la carcinogénesis cervical. Objetivos. Determinar el nivel de aceptación de la vacuna contra el virus del papiloma humano por parte de los tutores de las niñas candidatas y los factores asociados en un área de Resistencia, Chaco. Métodos. Estudio cualicuantitativo. Se utilizó un muestreo aleatorio simple sobre la base de listas escolares. Se incluyeron los tutores que refirieron tomar decisiones respecto a la salud de sus niñas, en el año 2012. Se utilizó un cuestionario estructurado en 4 constructos, que medían la aceptabilidad global. Se estudió la asociación entre aceptabilidad global y las variables sociodemográficas. Resultados. La frecuencia de aceptación fue 46,6% (IC 95%: 34,8-58,6). De los tutores, el 84,2% fueron mujeres; la media de edad fue 38,3 años (IC 95%: 36,7-39,8). La frecuencia de práctica de religión fue 86,8% (77,1-93,5); el 55,2% practicaban la religión católica y el 44,8%, evangelista. El 18,9% tenia más de una niña candidata a recibir la vacuna. El 85,5% refirió que había escuchado hablar del virus en algún momento y el 52,7% conocía la existencia de la vacuna para prevenirlo. La aceptación fue significativamente mayor en los tutores de las niñas que habían recibido la primera dosis de la vacuna (OR 8,02; IC 95%: 2,29-28,01; p= 0,0011). Conclusiones. La frecuencia de aceptación fue baja y no se encontró una asociación de los factores sociodemográficos y psicosociales con la decisión de vacunar a las niñas contra el virus del papiloma humano.

Introduction, In Argentina, every year, 3000new cases of cervical cancer are diagnosed and more than 2000 deaths occur as a result of this disease. Human papillomavirus (HPV) is the main risk factor for cervical carcinogenesis. Objectives. To establish the extent of acceptance of HPV vaccines and associated factors among legal guardians of candidate girls in an area of Resistencia, Chaco. Methods. Qualitative and quantitative study. A single randomized sampling was done based on school enrollment lists. Guardians who reported making decisions regarding girls' health in 2012 were included. A structured questionnaire made up offour constructs was used to measure overall acceptability. The association between overall acceptability and sociodemographic outcome measures was assessed. Results. The rate of acceptance was 46.6% (95% confidence interval: 34.8-58.6). Among guardians, 84.2% were women; their mean age was 38.3 years old (95% confidence interval: 36.7-39.8). Religion was practiced by 86.8% (77.1-93.5), 55.2% were Catholic and 44.8%, Evangelical Protestants. Guardians with more than one candidate girl for the vaccine accounted for 18.9%. Also, 85.5% referred having heard about the virus at some point, and 52.7% knew that a vaccine could prevent it. Acceptance was significantly higher among guardians of those girls who had received the first vaccine dose (OR: 8.02, 95% confidence interval: 2.29-28.01, p= 0.0011). Conclusions. The rate of acceptance was low and no association was observed between sociodemographic and psychosocial factors and the decision to have girls vaccinated with the HPV vaccine.

A prevenção da infecção pelo HPV e o câncer cervical / Prevention of HPV infection and cervical cancer

O Papilomavírus Humano está comprovadamente associado ao surgimento de lesões benignas e malignas incluindo o câncer do colo do útero. Mesmo sendo uma patologia com bons métodos de rastreio e diagnóstico precoce, anualmente milhares de mulheres em todo o mundo são acometidas pela infecção e posterior surgimento de lesões a esse vírus associadas, principalmente em países mais pobres. Após o entendimento destes vírus e de suas micropartículas, foram realizados estudos para a tentativa da produção de um agente imunizador que pudesse servir de prevenção primária para reduzir os níveis tão elevados desta doença e as mortes por ela provocadas em todo o mundo. No Brasil, a vacina foi instituída no Programa de Nacional de Imunizações em 2014. Mas ainda não há dados de seguimento para avaliar o impacto dessa prevenção no futuro. Este estudo tem como meta fazer uma revisão dos principais aspectos do Papilomavírus Humano e os comentários das vacinas já aprovadas para utilização.(AU)

The human papillomavirus is demonstrably associated with the development of benign and malignant lesions including cervical cancer. Although it is a good condition to methods of screening and early diagnosis annually thousands of women worldwide are affected by the infection and subsequent appearance of lesions associated with this virus, especially in poorer countries. After understanding these viruses and their microparticles studies were performed to attempt the production of an immunizing agent that could serve as the primary prevention to reduce such high levels of this illness and deaths caused by it worldwide. In Brazil, the vaccine was introduced in the National Immunization Program in 2014. But there is no tracking data to evaluate the impact of prevention in the future. This study aims to review the main aspects of the human papillomavirus, the main injuries and vaccines already approved for use.(AU)

Immunotherapy for human papillomavirus-associated disease and cervical cancer: review of clinical and translational research / 부인종양

Cervical cancer is the fourth most lethal women's cancer worldwide. Current treatments against cervical cancer include surgery, radiotherapy, chemotherapy, and anti-angiogenic agents. However, despite the various treatments utilized for the treatment of cervical cancer, its disease burden remains a global issue. Persistent infection of human papillomavirus (HPV) has been identified as an essential step of pathogenesis of cervical cancer and many other cancers, and nation-wide HPV screening as well as preventative HPV vaccination program have been introduced globally. However, even though the commercially available prophylactic HPV vaccines, Gardasil (Merck) and Cervarix (GlaxoSmithKline), are effective in blocking the entry of HPV into the epithelium of cervix through generation of HPV-specific neutralizing antibodies, they cannot eliminate the pre-existing HPV infection. For these reason, other immunotherapeutic options against HPV-associated diseases, including therapeutic vaccines, have been continuously explored. Therapeutic HPV vaccines enhance cell-mediated immunity targeting HPV E6 and E7 antigens by modulating primarily dendritic cells and cytotoxic T lymphocyte. Our review will cover various therapeutic vaccines in development for the treatment of HPV-associated lesions and cancers. Furthermore, we will discuss the potential of immune checkpoint inhibitors that have recently been adopted and tested for their treatment efficacy against HPV-induced cervical cancer.

Clinical significance of human papillomavirus genotyping / 부인종양

Cervical cancer is the fourth most common cancer in women worldwide, and the human papillomavirus (HPV) is the main causative agent for its development. HPV is a heterogeneous virus, and a persistent infection with a high-risk HPV contributes to the development of cancer. In recent decades, great advances have been made in understanding the molecular biology of HPV, and HPV\'s significance in cervical cancer prevention and management has received increased attention. In this review, we discuss the role of HPV genotyping in cervical cancer by addressing: clinically important issues in HPV virology; the current application of HPV genotyping in clinical medicine; and potential future uses for HPV genotyping.

Controversias en torno a la utilización de la vacuna contra el virus del papiloma humano / Controversy regarding the use of the vaccine against human papillomavirus / Controvérsias sobre o uso da vacina contra o vírus do papiloma humano

La vacuna contra el virus del papiloma humano (HPV) se presenta como una medida de prevención primaria del cáncer de cuello de útero (CCU), segunda causa de muerte de las mujeres a nivel mundial. Esta vacuna genera una dicotomía a nivel social que obliga a pensar si verdaderamente es necesario administrarla. En este artículo se desarrollan las posibles causas de esta contrariedad con la finalidad de colaborar en la toma de decisión informada sobre la administración de la misma. Se revisan las vacunas disponibles, las recomendaciones para su uso y las controversias en cuanto a eficacia, seguridad, número de dosis requeridas, eficiencia en la prevención y participación ciudadana. Las vacunas contra el HPV ofrecen un enfoque prometedor para la prevención del CCU y las afecciones asociadas a estos virus, pero no reemplazan a otras estrategias de prevención debido a que no protegen contra todos los tipos de virus de HPV.

The Human Papillomavirus (HPV) vaccine is presented as a primary preventive measure of cervical cancer (CC), the second cause of women deaths in the world. This vaccine generates such social dichotomy that makes us consider whether its administration is really necessary. The possible causes of this controversy are developed in this article, with the aim of helping to make an informed decision about its administration. Available vaccines are reviewed, as well as use recommendations and controversy regarding effectiveness, security, required doses, prevention efficiency and people’s participation. HPV vaccines offer a promising approach to prevent cervical cancer and conditions associated with these viruses, but they do not replace other prevention strategies since they do not protect against all HPV types.

A vacina contra o vírus do papiloma humano (HPV) é apresentada como uma medida de prevenção primária do câncer do colo do útero (CCU), a segunda principal causa de morte entre as mulheres em todo o mundo. Esta vacina gera tal dicotomia ao nível social que obriga a pensar se é realmente necessário administrá-la. Neste artigo discutem-se as possíveis causas desta controvérsia, a fim de ajudar na tomada de decisões informadas sobre a sua administração. Consideram-se as vacinas disponíveis, as recomendações para seu uso e a polêmica sobre a sua eficácia, segurança, número de doses necessárias, a eficiência na prevenção e a participação cidadã. As vacinas contra o HPV oferecem uma abordagem promissória para a prevenção do CCU e das doenças associadas a estes vírus, mas não substituem outras estratégias de prevenção, por não protegerem contra todos os tipos de vírus do HPV.

Evaluación seguridad de la vacuna contra el Virus de Papiloma Humano / Safety evaluation of the Human Papilloma Virus vaccine

Introducción: El cáncer de cuello uterino es el tercer cáncer más frecuente en el mundo. El Virus del Papiloma Humano ha sido identificado como agente causal de este cáncer y otras lesiones anogenitales. Más de 35 tipos del VPH infectan el tracto anogenital, los más comunes son el 6, 11, 16 y 18. El 6 y el 11 se consideran de bajo riesgo, pero los serotipos 16 y 18 son considerados de alto riesgo. Objetivo: actualizar la evaluación de seguridad de la Vacuna contra el Virus del Papiloma Humano en mujeres realizada en el 2013. Metodología: se realizó una evaluación crítica a través de una búsqueda sistemática en bases de datos electrónicas, diseñadas con vocabulario controlado y no controlado, además, de indagar con expertos sobre la disponibilidad de estudios publicados y no publicados, en inglés y español, la tamización de los resultados fue llevada a cabo por 2 revisores expertos. Los hallazgos de efectividad y seguridad fueron extraídos de los estudios con mejor calidad metodológica, buscando obtener información para todas las comparaciones y desenlaces de interés. Resultados: Se evidencian diferencias estadísticamente significativas en contra de la vacuna contra el VPH al evaluar la presencia de eventos adversos no serios locales, OR de 1.74 (IC 95% 1.27 ­ 2.40), Medeiros L (2009). No se evidencian diferencias estadísticamente significativas ante la presencia de eventos adversos no serios sistémicos y eventos adversos serios, OR de 1.18 (IC 95% 0.70 ­ 1.99). Medeiros L (2009) y RR de 1.82 (IC 95% 0.79 ­ 4.20) Lu Beibei (2011), \r\nrespectivamente. Conclusiones: La vacuna contra el VPH de acuerdo a la evidencia no tiene diferencias estadísticamente significativas en relación a la presencia de eventos adversos sistémicos y serio, \r\nen comparación con placebo o con otras vacunas (Hepatitis A y B).

Conhecimento e atitude de usuários do SUS sobre o HPV e as vacinas disponíveis no Brasil / SUS users? knowledge of and attitude to HPV virus and vaccines available in Brazil / SUS users? knowledge of and attitude to HPV virus and vaccines available in Brazil

OBJETIVO : Analisar o conhecimento de homens e mulheres acerca do HPV e das vacinas e sua intenção de serem vacinados e de vacinarem seus filhos adolescentes. MÉTODOS : Estudo descritivo, de corte transversal, com 286 mulheres (18 a 49 anos) e 252 homens (18 a 60 anos), usuários de cinco unidades básicas de saúde e duas policlínicas do Sistema Único de Saúde, em Campinas, SP, em 2011. Foi realizada entrevista estruturada. Realizou-se análise bivariada e regressão de Poisson para identificar variáveis associadas ao conhecimento sobre HPV e vacinas e à intenção de vacinação. RESULTADOS : Quase 40,0% dos entrevistados referiram ter ouvido falar do HPV e 28,9% mencionaram informações adequadas; a principal fonte de informação foi a mídia (41,7%); 8,6% tinham ouvido falar das vacinas. Depois de informados da existência das vacinas, cerca de 94,0% dos participantes disseram que se vacinariam e/ou vacinariam filhos adolescentes se as vacinas estivessem disponíveis na rede pública de saúde. Escolaridade > 8 anos e ser do sexo feminino estiveram independentemente associados a ter ouvido falar do HPV e das vacinas e a ter conhecimento adequado sobre o vírus. Maior idade associou-se a ter ouvido falar das vacinas. Não houve variáveis associadas à intenção de vacinação. CONCLUSÕES : Os resultados reforçam a necessidade de haver intervenções educativas na população para prover informação adequada sobre o HPV e sobre medidas de prevenção. .

Objetivo : Analizar el conocimiento de hombres y mujeres sobre el VPH y de las vacunas y su intención de ser vacunados y de vacunar sus hijos adolescentes. Métodos : Estudio descriptivo, de corte transversal, con 286 mujeres (18 a 49 años) y 252 hombres (18 a 60 años), usuarios de cinco unidades básicas de salud y dos policlínicas del Sistema Único de Salud, en Campinas, SP – Brasil, en 2011. Se realizó entrevista estructurada. Se utilizó el análisis bivariado y regresión de Poisson para identificar variables asociadas al conocimiento sobre VPH y vacunas y la intención de vacunación. Resultados : Casi el 40,0% de los entrevistados mencionaron haber oído hablar del VPH y 28,9% relataron informaciones adecuadas; la principal fuente de información fueron los medios de comunicación (41,7%); 8,6% habían oído hablar de las vacunas. Después de informados de la existencia de las vacunas, cerca de 94,0% de los participantes dijeron que se vacunarían y/o vacunarían hijos adolescentes si las vacunas estaban disponibles en la red pública de salud. Escolaridad > 8 años y ser del sexo femenino estuvieron independientemente asociados al haber oído hablar del VPH y de las vacunas y tener conocimiento adecuado sobre el virus Mayor edad se asoció al haber oído hablar de vacunas. No hubo variables asociadas a la intención de vacunación. Conclusiones : Los resultados refuerzan la necesidad de haber intenciones educativas en la población para proveer información adecuada sobre el VPH y sobre medidas de prevención .

OBJECTIVE : To investigate knowledge of HPV and HPV vaccines in men and women, users of the Brazilian Unified Health System, and the intention to get themselves and their teenage children vaccinated. METHODS : A descriptive, cross-sectional study with 286 women (18-49 years old) and 252 men (18-60 years old), users of five primary health units and two polyclinics in Campinas, SP, Southeastern Brazil, was carried out. Participants were interviewed in 2011 using a structured questionnaire. Bivariate and Poisson regression analysis were performed to identify variables associated with knowledge of HPV and HPV vaccines, and participants vaccination intentions. RESULTS : Almost 40.0% of the participants reported having heard of HPV and 28.9% mentioned adequate information. The main information source was the media (41.7%). Only 8.6% of the participants had heard of the HPV vaccines. Once the participants were informed of the existence of HPV vaccines about 94% of them said they would get vaccinated and/or vaccinate their teenage children, if the vaccines were available in the public health system. Schooling of over 8 years and being female were the variables independently associated with having heard of HPV, the vaccines and having adequate knowledge of the virus. Advanced age was associated with having heard of HPV vaccines. There were no variables associated with the vaccination intentions. CONCLUSIONS : These results reinforce the need for educational activities that provide the population with adequate information on HPV and preventive measures. .

Detección de virus papiloma humano en la prevención del cáncer cérvico-uterino / Human papilomavirus detection in cervical cancer prevention

El cáncer cérvico-uterino (CCU), que está fuertemente asociado a la infección por virus papiloma humano de alto riesgo (VPH-AR), sigue siendo un problema de salud pública en Latinoamérica. El uso de la citología para la detección de lesiones pre-cancerosas no ha tenido mayor impacto en las tasas de incidencia y mortalidad del CCU, que aún se mantienen altas en la región. La disponibilidad de nuevas técnicas de tamizaje para la detección de lesiones pre-cancerosas y de vacunas altamente eficaces que previenen casi todas las lesiones relacionadas con los VPH-AR de alto potencial oncogénico VPH 16 y 18, en mujeres no expuestas previamente al virus brindan una gran oportunidad para la prevención del CCU. La detección de VPH-AR representa actualmente un valioso componente de las guías clínicas para el tamizaje, manejo y tratamiento del CCU y sus lesiones precursoras. Se han desarrollado estrategias metodológicas que detectan un amplio espectro de tipos de VPH-AR; sin embargo, solo un pequeño subgrupo de ellas ha documentado la validación clínica para cualquiera de las indicaciones habituales de la detección de estos virus. Las pruebas de VPH que no estén validadas y que no hayan demostrado confiabilidad, reproducibilidad y exactitud no deben ser usadas en el manejo clínico. Una vez incorporada una prueba de VPH en el laboratorio, es esencial que el procedimiento completo sea sometido a un continuo y riguroso control de calidad para evitar prácticas subóptimas, potencialmente dañinas. Este artículo discute los recientes progresos y el estado actual de estos métodos.

Cervical cancer (CC), which is strongly associated to high-risk human papillomavirus (hr-HPV) infection, continues being a significant health problem in Latin America. The use of conventional cytology to detect precancerous cervical lesions has had no major impact on reducing CC incidence and mortality rates, which are still high in the region. New screening tools to detect precancerous lesions became available, which provide great opportunities for CC prevention, as do highly efficacious HPV vaccines able to prevent nearly all lesions associated with HPV-16 and -18 when applied before viral exposure. Currently, hr-HPV testing represents an invaluable component of clinical guidelines for screening, management and treatment of CC and their precursor lesions. Many testing strategies have been developed that can detect a broad spectrum of hr-HPV types in a single assay; however, only a small subset of them has documented clinical performance for any of the standard HPV testing indications. HPV tests that have not been validated and lack proof of reliability, reproducibility and accuracy should not be used in clinical management. Once incorporated into the lab, it is essential to submit the whole procedure of HPV testing to continuous and rigorous quality assurance to avoid sub-optimal, potentially harmful practices. Recent progress and current status of these methods are discussed in this article.

Acerca del cáncer cervicouterino como un importante problema de salud pública / About uterocervical cancer as an important public health problem

El cáncer se presenta como un importante problema de salud, dada la alta morbilidad y mortalidad que produce. Es uno de los procesos más complejos de la naturaleza y resulta el más complicado en la esfera de la medicina por su origen multicausal, la complejidad de sus mecanismos patogénicos y la variedad de formas y tipos que pueden originarse en el ser vivo. El objetivo de este trabajo es ofrecer información útil y actualizada acerca del cáncer cervicouterino. Esta enfermedad es prevenible y curable y se relaciona con la aparición del cáncer en vagina, cuello uterino, vulva y ano; en las mujeres se ha demostrado que la infección por el virus del papiloma humano es un factor de riesgo para su desarrollo. En la actualidad existen y se comercializan en el mundo dos tipos de vacuna, lo que se considera uno de los mayores avances en la medicina preventiva moderna. La aplicación de estas vacunas profilácticas contra el virus del papiloma humano podría reducir la incidencia y mortalidad por cáncer cervicouterino. Esta enfermedad constituye una de las entidades con más impacto y repercusión sobre la salud femenina, particularmente en las mujeres jóvenes. Está considerada una enfermedad emergente desde hace escasos años y sus consecuencias sociales, humanas y económicas lo convierten en un problema importante de salud pública y de la humanidad

Cancer represents an important health problem due to its high morbidity and mortality. It is one of the most complex processes of nature and the most complicated in medicine because of its multiple cause origin, the complexity of its pathogenic mechanisms and the variety of forms and types that may adopt in the subject alive. The objective of this paper was to provide useful and updated information on the uterocervical cancer. This disease is preventable and curable; it is related to the occurrence of cancer in the vagina, the uterine neck, the vulva and the anus. It has been proved that human papiloma virus infection is one of the risk factor for cancer in females. Two kinds of vaccine are marketed worldwide, and this is considered as one of the major advances in the modern preventive medicine. The administration of these prophylactic vaccines against the human papiloma could reduce the incidence and the mortality cause by uterocervical cancer, one of the diseases with high impact and repercussion on the female health, particularly in young females. It is considered an emerging disease and its human, social and economic consequences turn it into an important public health problem for mankind

Distribución genotipo-específico del virus papiloma humano entre hombres y mujeres de Caracas, Venezuela / Genotype-specific distribution of HPV between men and women od Caracas, Venezuela

Determinar la distribución de VPH entre hombres y mujeres con técnicas de biología molecular con la finalidad de aportar información epidemiológica para la evaluación de la utilidad del uso de las vacunas contra VPH en la población. Se procesaron muestras de hisopados endocervicales, uretrales, balano prepuciales, biopsias y cepillados cervicales, para extracción de ADN: Kit AxyPrep Body Fluid Viral DNA/RNA Miniprep (Axygen), para la amplificación: Kit INNO-LIPA HPV Genotyping Extra. Se recolectaron datos en el sistema electrónico INFOLAB. 1 545 pacientes en total fueron separados por sexo, grupo etario y amplificación de ADN-VPH. 77,6 por ciento de los pacientes del sexo masculino y 67,9 por ciento del sexo femenino resultaron positivos para la amplificación de ADN-VPH. Se encontró un pico de positividad entre los 30 a 34 años de edad (24,3 por ciento) al igual que para el sexo masculino (20,0 por ciento). En el sexo femenino 50,6 por ciento,0 por ciento a otros genotipos. En el sexo masculino 41,3 por ciento corresponde a VPH-AR, 34,6 por ciento VPH-BR y un 24,2 por ciento a otros genotipos. Los genotipos AR detectados con más frecuencia fueron VPH-52/51/16 y los de BR VPH-6/11. El cáncer cervical es un problema de salud pública. El tamizaje con citología no ha tenido impacto sobre la prevalencia, se sugiere el uso de pruebas más sensibles. Se debe evaluar el uso de la vacuna en conjunto con otras estrategias, realizando un análisis identificando las debilidades y fortalezas, con la finalidad de establecer programas de prevención óptimos

Determine the distribution of HPV in men and women with Molecular Biology techniques in order to provide epidemiological information to evaluate the usefulness of the HPV vaccine in the population. Samples of endocervical swabs, urethral, preputial, biopsies and cervical scrapes for DNA extraction: Body Fluid Kit AxyPrep Viral DNA / RNA Miniprep (Axygen) for the amplification: INNO-LIPA HPV Kit Extra Genotyping. Data were collected in the electronic system Infolab. 1 545 patients in total were separated by sex, age group and HPV DNA amplification. 77.6 percent of male patients and 67.9 percent of females were positive for HPV DNA amplification. We found a positive peak between 30 and 34 years of age (24.3 percent) as well as for males (20.0 percent). Among females 50.6 percent of genotypes identified corresponded to HR-HPV, 22.4 percent to HPV-LR, 27.0 percent for other genotypes. In males, 41.3 percent were HR-HPV, HPV-LR 34.6 percent and 24.2 percent other genotypes. AR genotypes detected more frequently were HPV- 52/51/16 and LR were HPV-6/11. Cervical cancer is a public health problem. Cytology screening has had no impact on the prevalence, we suggest the use of more sensitive tests. It is necessary to evaluate the use of the vaccine in conjunction with other strategies, analyzing the strengths and weaknesses identified, in order to establish optimal prevention programs

Profilaxis y tratamiento en la infeccion por VPH y el cáncer cervical / Treament and prolaxis for HPV and cervical cancer

Dada la importancia del cáncer cervical y la infección por VPH como problemas de salud pública en el mundo, diversas investigaciones se han enfocado en el desarrollo de vacunas profilácticas y terapéuticas para la prevención y/o tratamiento de esta enfermedad. Dentro de las estrategias terapéuticas, la terapia génica se proyecta como una estrategia clínica poderosa para la eliminación o regresión de las lesiones cancerosas a corto y mediano plazo. La presente es una revisión sobre los progresos de estas investigaciones

Given the importance of the cervical cancer and HPV infection as a public health problem in the entire world, several studies have focused on the development of the prophylactic and the therapeutic vaccines for the prevention and for the treatment of this disease. Among the therapeutic strategies, the gene therapy is projected as a powerful clinical strategy for elimination or regression of cancerous lesions in the short and medium term. This is a review on the progress of these investigations