Perceptions, Attitudes, and Barriers to Human Papillomavirus Vaccination Among Residents in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Human papillomavirus (HPV) infection is a prevalent sexually transmitted infection globally, with significant associations with various cancers. Despite the availability of HPV vaccines, vaccination uptake remains suboptimal in many regions, including Saudi Arabia. METHODS: This cross-sectional survey-based study aimed to assess perceptions, attitudes, and barriers related to HPV vaccination among residents in different regions of Saudi Arabia. Participants were recruited using a stratified sampling method, and data were collected through a structured questionnaire administered electronically. RESULTS: A total of 600 participants were included in the study, with diverse demographic profiles observed. The largest age group was 26-35 years old, comprising 42.7% (n = 256) of the sample. The distribution of gender was approximately equal, with 54.7% (n = 328) male participants. Notable perception and knowledge about HPV were observed, with 49.7% (n = 298) reporting being very familiar. Furthermore, 85.8% (n = 515) believed that HPV could cause serious health problems, and 63.7% (n = 382) perceived the vaccine to be very effective. Positive attitudes toward HPV vaccination were prevalent, with a significant proportion expressing a willingness to recommend the vaccine to themselves (70.0%, n = 420) and their children (65.0%, n = 390). Healthcare provider recommendation emerged as a key influencing factor, with 73.8% (n = 443) citing it as influential. Despite favorable attitudes, barriers to HPV vaccination were reported, including vaccine cost (22.5%, n = 135) and lack of awareness (13.7%, n = 82). However, a substantial proportion of unvaccinated participants cited not applicable reasons (57.2%, n = 343), indicating prior vaccination. Factors associated with HPV vaccination uptake included higher education levels, with those holding a master's degree or above exhibiting higher odds of vaccination uptake (OR (odds ratio): 1.80, 95% CI (confidence interval): 1.35-2.40, p < 0.001). Age (26-35 vs. 18-25) also showed a borderline significant association (OR: 1.25, 95% CI: 0.98-1.60, p = 0.074). CONCLUSION: The study highlights the importance of understanding perceptions and barriers to HPV vaccination to inform public health policies and programs in Saudi Arabia. Addressing identified barriers, such as educational campaigns and improving access to vaccination services, is essential for enhancing HPV vaccination coverage and reducing the burden of HPV-related diseases in the region.

Assessment of knowledge and perceptions of human papillomavirus vaccine and its determinants among women who have eligible daughters in Debre Berhan City, Ethiopia: a cross-sectional study.

Introduction: Globally, cervical cancer(CC) is the second most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths in women. Human papillomavirus (HPV) infection is the leading cause of CC. Persistent infection with HPV accounts for 90% of all CC cases. The human papillomavirus vaccine has the great potential to prevent HPV-related infections for millions of women and men. The current study aimed to assess knowledge and perceptions towards the HPV vaccine and its determinants among women who have eligible daughters in Debre Berhan City, Ethiopia. Methods: A cross-sectional study was conducted from April 2, 2023, to May 15, 2023. A multistage sampling procedure was used to recruit 607 women participants. Descriptive statistics were used to summarize socio-demographic data. Univariable and multivariable binary logistic regression analyses were performed to measure the associations between the dependent and independent variables. A p-value of <0.05 was considered statistically significant. Results: More than three-fourths of the participants, 479 individuals (80%) were currently married, and 243(40.1%) had a diploma or higher education level. Of 456(75.12) participants reported, they had information about cervical cancer. For 449(73.9%) of the participants, television was the main evidence. The majority of 352(59.99%) participants knew the HPV vaccine could be offered to a female child aged 9-14 years old. Only 215(35.4%) participants think the HPV vaccine was safe and effective. Women who had a degree and above educational level were about 9 times more likely to have good knowledge about the HPV vaccine than study participants who did not read and write (AOR=9.21; 95% CI=2.82-12.16; p=0.004). Women who did not have information about the HPV vaccine before this study were about 80% less likely to have a positive perception of the HPV vaccine than participants who had earlier information about the HPV vaccine (AOR=0.8; 95%CI=0.63-0.49; P=003). Conclusion: Women had poor knowledge and perceptions about the HPV vaccine. Maternal marital status, age, and having information about the HPV vaccine were the only predictors of women's knowledge of the HPV vaccine.

Human papillomavirus vaccination uptake and determinant factors among adolescent schoolgirls in sub-Saharan Africa: A systematic review and meta-analysis.

Despite the ongoing global vaccination campaign aimed at preventing human papillomavirus (HPV) related health issues, the uptake of the HPV vaccine remains unacceptably low in developing regions, particularly in sub-Saharan Africa (SSA). Therefore, this systematic review and meta-analysis aimed at determining the pooled prevalence and associated factors of HPV vaccine uptake among adolescent school girls in SSA. Electronic bio-medical databases were explored. Pooled prevalence, publication bias, meta-regression, sub-group, and sensitivity analysis were performed. The estimated pooled prevalence of HPV vaccine uptake was 28.53% [95% CI: (5.25, 51.81)]. Having good knowledge and a positive attitude was significantly associated with HPV vaccine uptake in SSA. Subgroup analysis revealed the highest uptake was 62.52% from Kenya and the lowest was 3.77% in Nigeria. The HPV vaccine uptake is low. It underscores the need for community education, school-based immunization, and education programs that promote the uptake of the vaccine to increase coverage.

Analysis of influencing factors of HPV vaccination willingness of female sex workers in urban entertainment venues based on the IMB model in Guangxi, China.

OBJECTIVE: Understanding HPV vaccination willingness and its influencing factors among female sex workers (FSWs) in entertainment venues in an urban area of Guangxi, China. METHODS: From 15 August to 15 October 2022, FSWs in entertainment venues with commercial sex trade in an urban area of Guangxi were selected as the study subjects for the questionnaire survey using the method of intentional sampling. The questionnaire based on the information-motivation-behavior (IMB) skills model was used to collect the basic characteristics, HPV and HPV vaccine-related information and cognition, motivation to vaccinate, behavioral skills and willingness to vaccinate from the research targets. A multifactor logistic regression model was used to analyze the factors influencing the research targets' willingness to receive HPV vaccination. RESULTS: Of the 921 research targets, 712 (77.31%) were willing to receive HPV vaccination. The higher the level of knowledge regarding HPV and HPV vaccine-related information, the higher the motivation for HPV vaccination. In addition, the higher the behavioral skills score, the higher the willingness of FSWs in entertainment venues to receive HPV vaccination (P<0.001). FSWs in entertainment venues with lower venue grades [OR(95% CI)=0.693 (0.539, 0.891), P=0.004] were more reluctant to receive HPV vaccination. Those who favored the effectiveness of the vaccine in preventing the disease [OR(95% CI)=2.144 (1.449, 3.174), P<0.001] and those who had heard of HPV vaccine [OR(95% CI)=2.105 (1.451, 3.054), P<0.001], were able to perceive the benefits of HPV vaccination [OR(95% CI)=1.134 (1.045, 1.230), P=0.002]. These individuals acquired greater behavioral skills i.e., self-decision making for HPV vaccination [OR(95% CI)=1.130 (1.008, 1.267), P=0.036] and self-efficacy [OR(95% CI)=1.135 (1.081, 1.191), P<0.001] and they were more willing to receive HPV vaccine. CONCLUSIONS: There was a relatively high HPV vaccination willingness among FSWs in entertainment venues in an urban area of Guangxi, China. Attention should be focused on introducing the benefits of primary prevention measures such as the HPV vaccine for individuals and behavioral skills for HPV vaccination in order to increase their willingness to be vaccinated thus increasing their HPV vaccination rate.

Knowledge, Attitudes, and Perceptions Towards Human Papillomavirus (HPV) Vaccination Among Adult Women in Primary Health Care Centers in Makkah, Saudi Arabia.

BACKGROUND: Human papillomavirus (HPV) is linked to cervical cancer, which is prevalent in Saudi Arabia. While HPV vaccines are effective, their coverage remains low in low- and middle-income countries. Public awareness of HPV vaccination is also limited. The study examines public awareness of cervical cancer, HPV, the HPV vaccine, and factors that hinder vaccine uptake. OBJECTIVES: To assess the levels of knowledge, attitudes, and perceptions towards HPV vaccination among women aged 16 years and above in Makkah, Saudi Arabia. METHODS: An analytical cross-sectional study was conducted using an interview questionnaire. A stratified sampling technique was used to select a representative sample of 534 female patients aged 16 years and older who visited primary healthcare centers in Makkah. The interview questionnaire included questions related to sociodemographic characteristics, knowledge about HPV vaccination, attitudes and perceptions toward HPV vaccination, and sources of information about HPV infection and vaccines. The data were analyzed using descriptive statistics and chi-square tests. RESULTS: The majority of participants were aged between 21 and 40 years (76.4%), Saudi (90.3%), and had a higher education level (73.4%). Only a small proportion (1.9%-39%) of participants correctly answered most of the questions related to HPV vaccination, while a few questions were answered correctly by a larger proportion (41.6%-59.6%), highlighting the need for educational programs to increase awareness about the HPV vaccine. The internet and social media were the most prevalent sources of information about HPV infection and vaccines (48.4%). A majority of participants expressed willingness to receive the HPV vaccine if offered by the healthcare sector at no cost (65.5%). Concerns included fear of injection (27.7%), cost (23.2%), and potential refusal from family or community (9.7%). A significant proportion believed that there is a need for educational sessions to increase awareness about the HPV vaccine in their community (82.8%) and that increased knowledge about HPV vaccines would lead to greater acceptability (83.9%). Age, nationality, marital status, number of children, educational status, occupation, and average monthly income were significantly associated with knowledge about HPV vaccination (p < 0.05). Age and educational status were significantly associated with attitudes towards HPV vaccination (p < 0.05). CONCLUSION: The lack of knowledge about HPV vaccination among adult women in Makkah, Saudi Arabia, is concerning, as it may result in low vaccine uptake rates and an increased incidence of HPV-related diseases. Therefore, targeted educational programs and awareness campaigns are crucial to enhance knowledge and promote the uptake of the HPV vaccine. These programs should be designed to provide accurate information about the prevalence of HPV, its associated risks, and the benefits of vaccination.

Knowledge about cervical cancer risk factors and human papilloma virus vaccine among Saudi women of childbearing age: A community-based cross-sectional study from Saudi Arabia.

Objective: To examine the knowledge of cervical cancer risk factors and human papilloma virus (HPV) vaccine among Saudi women of childbearing age. Methods: An anonymous, survey-based, cross-sectional study was conducted from November 2022 to March 2023. Results: Overall, 422 participants were included in the current study. Most participants were within the age group of 15-25 years old (42.9%), single (47.9%), and educated with a bachelor's degree (70%). Out of a total of 14 points, the average knowledge score for all participants was 7.3 ± 2.31 (range: 2-14). More than three-quarters of the surveyed participants correctly identified the following risk factors for cervical cancer: multiple sexual partners (78.2%), having weakened immunity (82.7%), infection with HPV (82.9%), and positive family history of cervical cancer (88.9%). Concerning HPV vaccine, 153 (36.3%) participants heard about HPV vaccine and only 20 (4.4%) of them were vaccinated. Only 128 (30.3%) participants stated correctly that 9-13 years old is the best age to start HPV vaccine, whereas 51 (12.1%) participants correctly stated the number of HPV vaccine doses to be three over six months. Overall, 167 (39.6%) participants declined to receive the HPV vaccine. The three most frequently reported reasons included not hearing about HPV vaccine (35.3%), fear from HPV-related side effects (30.5%), and apprehension from HPV vaccine injection (16.2%). Among several socio-demographic characteristics, occupation was statistically significantly associated with knowledge score (p < 0.001), with students in health specialties tended to have the highest knowledge score compared with others. Conclusion: Most participants displayed good knowledge about cervical cancer risk factors, but not about HPV vaccine. Very alarmingly, less than 5% of the participants received HPV vaccine and close to 40% of them declined to receive the HPV vaccine. Mechanisms to increase public awareness about HPV vaccine and its acceptance by women are recommended.

Factors associated with uptake of human papilloma virus vaccine among school girls aged 9-14 years in Lira City northern Uganda: a cross-sectional study.

BACKGROUND: Cervical cancer is the most common Human Papilloma Virus (HPV)-related disease among women. Since 2008, HPV vaccination has been routinely recommended for pre-adolescent and adolescent girls in Uganda as the primary preventive measure for cervical cancer. However, in Uganda, most especially in Lira district, there is limited literature on HPV vaccination uptake and associated factors among girls aged 9-14years. This study assessed the uptake of HPV vaccine and associated factors among in-school girls aged 9-14 years in Lira City, northern Uganda. METHODS: A cross-sectional study was conducted among 245 primary school girls aged 9-14 years in Lira City, northern Uganda. Multistage sampling technique was used to sample eligible participants and data was collected using interviewer administered questionnaire. Data was analysed using SPSS version 23.0. Descriptive statistics and multivariate logistic regression at 95% level of significance were used to identify the level of HPV vaccine uptake and predictors respectively. RESULTS: HPV vaccination uptake was at 19.6% (95% CI,14.8-25.1) among the school girls aged 9-14 years in Lira City, northern Uganda. The mean age of the girls was 12.11 (± 1.651) years. Predictors that were independently associated with HPV vaccine uptake included; recommendation from health worker [aOR 9.09, 95% CI (3.19-25.88), P ≤ 0.001], taught about cervical cancer at school [aOR,12.56, 95% CI (4.60-34.28), P ≤ 0.001], and exposure to outreach clinics [aOR, 4.41, 95% CI (1.37-14.19), P = 0.013]. CONCLUSION: The study found that one in five of the school girls in Lira City, northern Uganda. received HPV vaccine. Girls who were taught about cervical cancer at school, exposure to outreach clinics and received health worker recommendation had more odds of receiving HPV vaccine than their counter parts. The Ministry of Health should strengthen school based cervical cancer education, awareness raising about HPV vaccination and health worker recommendations to improve HPV vaccine uptake among school girls in Uganda.

Human Papilloma Virus Infection and Vaccine Knowledge Levels, Attitudes, Beliefs in University Students: Turkey and Ghana Comparison.

Purpose: Studies reported that early diagnosis, treatment, and prevention of cervical cancer are influenced by knowledge, beliefs, and attitude toward screening. This descriptive-comparative study aimed to assess human papilloma virus (HPV) knowledge, attitudes, and beliefs in university students and the affecting factors and to compare between Turkish and Ghanaian students. Methods: The sample consists of 933 university students studying in 4 different faculties in 2 universities from Turkey and Ghana. The data were collected between November 2019 and February 2020. The study's data were analyzed using Analysis of Variance, Pearson Correlation test, t-test, and Mann-Whitney U test. Results: The findings of the study showed that none of the students in both countries had HPV vaccination. It was found that students have low level of knowledge about HPV infection and vaccine (3.28 ± 2.14) and positive attitudes (16.57 ± 3.28) and beliefs (36.74 ± 6.55) toward vaccine. The attitude score of the Ghanaian students (17.54 ± 3.23) was found to be significantly higher than the Turkish students (15.74 ± 3.09). The knowledge score of the Ghanaian students who had sexual intercourse was found to be significantly higher than others. The findings of the study revealed that the students of both countries had low level of knowledge about HPV infection and vaccine and positive attitudes and beliefs toward the vaccine. Conclusions: It is recommended to increase effective interventions to increase the knowledge level of university students about HPV infection and vaccine. In addition, the vaccine should be included in the immunization program in both countries.

A Single Dose, Thermostable, Trivalent Human Papillomavirus Vaccine Formulated Using Atomic Layer Deposition.

Formulations of human papillomavirus (HPV) 16, 18, and 31 L1 capsomere protein antigens were spray dried to obtain glassy microspheres that were then coated by atomic layer deposition (ALD) with nanometer-thin protective layers of alumina. Spray-drying was used to formulate human papillomavirus (HPV) 16, 18, and 31 L1 capsomere protein antigens within glassy microspheres to which nanoscopic protective layers of alumina were applied using ALD. Suspensions of alumina-coated, capsomere-containing microparticles were administered in a single dose to mice. ALD-deposited alumina coatings provided thermostability and a delayed in vivo release of capsomere antigens, incorporating both a prime and a boost dose in one injection. Total serotype-specific antibody titers as well as neutralizing titers determined from pseudovirus infectivity assays were unaffected by incubation of the ALD-coated vaccines for at 4, 50, or 70 °C for three months prior to administration. In addition, even after incubation for three months at 70 °C, single doses of ALD-coated vaccines produced both higher total antibody responses and higher neutralizing responses than control immunizations that used two doses of conventional liquid formulations stored at 4 °C.

Awareness of human papillomavirus vaccine knowledge and willingness to receive human papillomavirus vaccination among women in Hainan Province / 预防医学

Objective@#To investigate the awareness of human papillomavirus (HPV) vaccine knowledge among women in Hainan Province and the willingness to receive HPV vaccination among women and their daughters, so as to provide insights into HPV vaccine promotion and cervical cancer control. @*Methods@#Women aged 20 to 64 years who participated in the cervical cancer screening program in Hainan Province from July 2021 to February 2022 were enrolled, and participants' demographics, awareness of knowledge about HPV vaccine, and willingness to receive HPV vaccination among themselves and their daughters using a questionnaire survey. The factors affecting willingness to receive HPV vaccination were identified using a multivariable logistic regression model.@*Results@#A total of 4 300 questionnaires were allocated and 4 023 valid questionnaires were recovered, with an effective recovery rate of 93.56%. The respondents had a mean age of (35.52±6.48) years, and their daughters had a mean age of (8.93±4.83) years. There were 826 participants knowing HPV vaccine-related knowledge, with an awareness rate of 20.35%. The proportions of willingness to receive HPV vaccination were 75.07% among respondents and 71.36% among their daughters. Multivariable logistic regression analysis identified age (20 to <30 years, OR=1.474, 95%CI: 1.167-1.862; 30 to <40 years, OR=1.455, 95%CI: 1.199-1.765), urban-registered residence (OR=1.251, 95%CI: 1.016-1.541), monthly household income (3 000 to <5 000 Yuan, OR=1.568, 95%CI: 1.314-1.873; 5 000 Yuan and more, OR=1.231, 95%CI: 1.014-1.496), affordable fees for a single dose of HPV vaccination (100 to <500 Yuan, OR=1.358, 95%CI: 1.159-1.590; 500 Yuan and higher, OR=1.609, 95%CI: 1.188-2.180), and awareness of HPV vaccine-related knowledge (OR=4.473, 95%CI: 3.416-5.855) as factors affecting respondents' willingness to receive HPV vaccination, and participation in New Rural Cooperative Medical Insurance (OR=1.652, 95%CI: 1.087-2.511), affordable fees for a single dose of HPV vaccination (100 to <500 Yuan, OR=1.905, 95%CI: 1.633-2.221; 500 Yuan and higher, OR=1.683, 95%CI: 1.275-2.223), awareness of HPV vaccine-related knowledge (OR=3.625, 95%CI: 2.847-4.615), daughter's active request for HPV vaccination (OR=1.695, 95%CI: 1.293-2.222), and frequency of sexual health education for daughters (frequently, OR=2.142, 95%CI: 1.789-2.564; occasionally, OR=1.707, 95%CI: 1.416-2.059) as factors affecting the willingness to receive HPV vaccination among respondents' daughters. @*Conclusions@#The awareness of HPV vaccine-related knowledge is low among women aged 20 to 64 years in Hainan Province, and the women's and their daughters' willingness to receive HPV vaccination is associated with age, household registration, economic level, price of HPV vaccine and awareness of HPV vaccine-related knowledge.

Penile cancer: Updates in systemic therapy.

Penile cancer is a rare genitourinary malignancy with a greater incidence in parts of Asia, South America, and Africa. Outcomes are very poor in patients with advanced disease and in those who do not respond to first-line multimodal therapy. Among systemic therapy options, platinum-based chemotherapy is used in the first-line; however, approximately half of patients do not benefit. Response rates to systemic therapy as subsequent line treatment are historically dismal. There is also a paucity of prognostic and predictive tools within the context of penile cancer. As such, there remains an urgent need to expand systemic treatment options for patients with advanced penile cancer. The purpose of this review is to summarize the existing evidence for standard-of-care lines of systemic treatment, examine the potential of novel lines of systemic therapy, and provide an update as to the status of these new therapies within the context of penile cancer.

Health literacy and its association with human papilloma virus vaccination among adults: Findings from the behavioral risk factor surveillance system.

Health literacy is associated with the utilization of preventive health services. We examined the association between health literacy (HL) levels and receipt of at least one dose of the human papilloma virus (HPV) vaccination. We analyzed the data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) among adults aged 18 to 32. The primary outcome variable was the 'yes/no' response to the question that assessed whether the participant received at least the first dose of HPV vaccination. The primary independent variable was a summative HL score (range 3 through 12) we created for each respondent by adding the scores for all three HL questions. We performed bivariate and multivariable (logistic regression) analyses to examine the relationship between study variables. The analytical sample of 6,731 adults aged 18 to 32 met the eligibility criteria. Regression analyses showed that the odds of having received at least one dose of HPV vaccination increased by 13% for every unit increase in health literacy score (Odds ratio: 1.13, 95% CI:1.06-1.21, p < .0001). Age, gender, marital status, race/ethnicity, insurance status, and having regular access to a personal doctor were predictors of HPV vaccination status. This study showed that higher levels of HL may contribute to the uptake of at least one dose of the HPV vaccine. Health care and public health organizations, health care professionals, and policymakers should emphasize improving the health literacy levels of the patients and the public to increase the uptake of the HPV vaccine.

Recurrent, non-traumatic, non-exertional rhabdomyolysis after immunologic stimuli in a healthy adolescent female: a case report.

BACKGROUND: Dysferlinopathy refers to a heterogenous group of autosomal recessive disorders that affect a skeletal muscle protein called dysferlin. These mutations are associated with limb-girdle muscular dystrophy type 2B, Miyoshi myopathy, asymptomatic hyperCKemia, and distal myopathy with anterior tibial onset. CASE PRESENTATION: A 16 year old female presented with myalgia, weakness and dark urine one week after her second BNT162b2 mRNA (Pfizer) vaccine. Initial serum creatine kinase (CK) was measured at 153,000 IU/L, eventually up-trending to over 200,000 IU/L. However, stable renal function precluded hemodialysis allowing discharge after 10 days of intravenous (IV) hydration and alkaline diuresis. Just two years prior to the current presentation, the patient was hospitalized following Group A Streptococcal pharyngitis infection complicated by rhabdomyolysis. She presented with fatigue, lower extremity weakness, and dark oliguria with CK measuring 984,800 IU/L. IV hydration was attempted however hemodialysis was ultimately required throughout her 24-day hospital stay. Her episode was presumed to be idiopathic and no further work-up was performed at that time. During the patient's current hospitalization, she reported similar symptomology (myalgias and weakness) following her first quadrivalent Gardasil vaccine at age 11. No hospitalization was required at that time. A comprehensive workup was now initiated while the patient was being treated for her suspected second or third non-exertional, non-traumatic rhabdomyolysis. Rheumatologic, metabolic, infectious, and endocrinologic workup were all unremarkable. Patient eventually had whole exome sequencing performed which revealed a heterozygous pathogenic variant in the DYSF gene (DYSF c.2643 + 1G > A) encoding dysferlin. No clinically significant sequelae occurred thus far. CONCLUSIONS: While there have been reports of symptomatic heterozygote carriers of dysferlinopathies, to our knowledge none have been associated with recurrent rhabdomyolysis after immunogenic stimuli. This unique case presentation highlights the importance of a multi-disciplinary care team, the utility of modern whole-exome gene sequencing, and the future challenges of balancing vaccine risk vs benefit.

Parental intention to vaccinate adolescents with HPV vaccine in selected communities in Ibadan, Southwest Nigeria: an application of Integrated Behavioral Model.

Parents have important roles to play for adolescents to get the human papillomavirus (HPV) vaccine, an effective measure in the prevention of cervical and other HPV-related cancers. It is important to understand the intention of parents to have their adolescents vaccinated for optimal uptake of the vaccine in Nigeria. This study investigated the intention of parents in five selected communities to get their adolescents vaccinated with HPV vaccine in Ibadan, Nigeria using the Integrated Behavioral Model (IBM). Cross sectional study design was employed and 678 parents were interviewed. Pearson correlation, chi-square test and multiple regression were used for data analysis at α = 0.05. Mean age of the parents was 42.5 ± 10.0 years and 230(33.9%) were males. Almost all of the parents (96.8%) had the intention to vaccinate their adolescents with HPV vaccine. This intention was significantly correlated with experiential attitude (r = 0.74, p = <.01), instrumental attitude (r = 0.33, p = <.01), injunctive norm (r = 0.39, p = <.01), descriptive norm (r = 0.32, p = <.01), perceived control (r = 0.32, p = <.01) and self-efficacy (r = 0.46, p ≤ .01). A higher proportion of parents older than 65 years significantly had no intention to vaccinate their adolescents with HPV vaccine. Intention to vaccinate adolescents with HPV vaccine was predicted by experiential attitude (OR = 0.88, 95% CI: 0.80-0.95), personal agency (OR = 0.22, 95% CI: 0.15-0.29) and injunctive norm (OR = 0.08, 95% CI: 0.02-0.13). Parental intention to vaccinate adolescents with HPV vaccine was high among the parents in this study. The reluctance of older parents about HPV vaccine for adolescents requires further investigation.

Medical factors associated with caregiver intention to vaccinate their children against COVID-19.

OBJECTIVE: To describe medical factors that are associated with caregiver intention to vaccinate their children against COVID-19. METHODS: We conducted a cross-sectional study of families receiving primary care in a mid-Atlantic pediatric healthcare system, linking caregiver-reported data from a survey completed March 19 to April 16, 2021 to comprehensive data from the child's EHR. RESULTS: 513 families were included (28% Black, 16% Hispanic, 44% public insurance, 21% rural, child age range 0-21 years). 44% of caregivers intended to vaccinate their children against COVID-19, while 41% were not sure and 15% would not. After adjusting for socio-demographics, the only medical factors that were associated with caregiver COVID-19 vaccine hesitancy were caregiver COVID-19 vaccination status at the time of the survey (aOR 3.0 if the caregiver did not receive the vaccine compared to those who did, 95% CI 1.7-5.3) and child seasonal influenza immunization history (aOR 3.3 if the child had not received the influenza vaccine in the 2020-2021 season compared to those who did, 95% CI 2.0-5.4). Other medical factors, including family medical experiences with COVID-19, other child immunization history, child health conditions like obesity and asthma, and family engagement with the healthcare system were not associated with caregiver intention to vaccinate their children against COVID-19. CONCLUSIONS: This study highlights important factors, such as general attitudes towards vaccines and understanding of COVID-19 morbidity risk factors, that healthcare providers should address when having conversations with families about the COVID-19 vaccine.

Post-HPV-Vaccination Mast Cell Activation Syndrome: Possible Vaccine-Triggered Escalation of Undiagnosed Pre-Existing Mast Cell Disease?

For nearly a decade, case reports and series have emerged regarding dysautonomias-particularly postural orthostatic tachycardia syndrome (POTS)-presenting soon after vaccination against human papilloma virus (HPV). We too have observed a number of such cases (all following vaccination with the Gardasil product), and have found several to have detectable mast cell activation syndrome (MCAS) as well as histories suggesting that MCAS was likely present long before vaccination. We detail 11 such cases here, posing a hypothesis that HPV vaccination (at least with the Gardasil product) may have triggered or exacerbated MCAS in teenagers previously not recognized to have it. Only recently recognized, MCAS is being increasingly appreciated as a prevalent and chronic multisystem disorder, often emerging early in life and presenting with inflammatory ± allergic phenomena following from known mast cell (MC) mediator effects. There is rising recognition, too, of associations of MCAS with central and peripheral neuropathic disorders, including autonomic disorders such as POTS. Given the recognized potential for many antigens to trigger a major and permanent escalation of baseline MC misbehavior in a given MCAS patient, we hypothesize that in our patients described herein, vaccination with Gardasil may have caused pre-existing (but not yet clinically recognized) MCAS to worsen to a clinically significantly degree, with the emergence of POTS and other issues. The recognition and management of MCAS prior to vaccinations in general may be a strategy worth investigating for reducing adverse events following HPV vaccinations and perhaps even other types of vaccinations.

Contralateral Recurrences of Post-vaccination Multiple Evanescent White Dot Syndrome.

We report on a case of multiple evanescent white dot syndrome (MEWDS) following the simultaneous administration of the human papillomavirus and meningococcal (conjugate) vaccines and two recurrences of MEWDS following the administration of the second dose of the human papillomavirus (HPV) vaccine and the COVID-19 vaccine and COVID-19 viral infection. A 17-year-old Hispanic female presented with a one-week history of photopsia and blurred vision in her left eye following the simultaneous administration of the human papillomavirus and meningococcal (conjugate) vaccines. Upon a comprehensive examination, her best-corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye. A left fundus examination revealed multiple white dots in the macula and nasal periphery, consistent with a diagnosis of MEWDS. Ancillary testing, including fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and optical coherence tomography, supported the diagnosis. One month following her initial diagnosis, the patient's symptoms had resolved without any therapy, and a fundus examination revealed multiple relatively ill-defined brown-colored subretinal lesions in the nasal midperiphery, corresponding to the location of the previous MEWDS lesions. Subsequently, she received the second dose of the HPV vaccine and then developed a mild COVID-19 infection. Four months after the initial presentation, she received the first dose of the BNT162b2 COVID-19 vaccine, followed by the second dose a month later. Eight months following her initial presentation, she presented with photopsia in the right eye. Her visual acuity remained 20/20 in the right eye and improved to 20/20 in the left eye, and white dots were identified nasal to the disk and surrounding the peripapillary region; the contralateral MEWDS diagnosis was confirmed by the previously mentioned ancillary tests. At her one-month follow-up, she presented new onset photopsia of the right eye. Her visual acuity remained 20/20 in both eyes, and a fundus examination revealed white lesions suggestive of active MEWDS temporal to the macula and brown-colored spots nasal to the disk, suggestive of recovering MEWDS, nasally. The aforementioned testing confirmed the coexistence of new and resolving lesions; nonetheless, the patient's symptoms resolved without any therapy, and she received the third dose of the BNT162b2 COVID-19 vaccine 11 months after her initial presentation. Our case suggests that vaccines may serve as immunological triggers of MEWDS. Recurrent MEWDS may occur when an individual is exposed to a powerful immune challenge, such as receiving a wide array of vaccinations in a short period of time. We believe this case constitutes a previously undescribed finding of multiple relatively ill-defined brown-colored subretinal lesions present in late MEWDS.

Analysis of HPV vaccination behavior based on diffusion of innovation / 预防医学

Objective@#To understand the behavioral characteristics of vaccination of human papillomavirus (HPV) vaccine based on diffusion of innovation theory, and to put forward suggestions for improving the vaccination willingness.@*Methods@#The women who had made an appointment or received at least one dose of HPV vaccine in two community health service centers with HPV vaccination qualification in Hangzhou were recruited by convenience sampling method. A questionnaire survey was conducted according to cervical cancer risk factors, HPV vaccine knowledge and the time of vaccination. The diffusion of HPV vaccination and the characteristics of vaccinees in different stages was analyzed.@*Results@#A total of 448 women, aged from 18 to 45 years old, with a median of 30.5 years old, were investigated. The spread of HPV vaccine were divided into five stages: April 2017 and before was the initial stage, with 8 leaders, accounting for 1.79%; October 2017 to February 2018 was the slowly rising stage, with 59 early vaccinees, accounting for 13.17%; April 2018 to April 2019 was the rising stage, with 160 most early vaccinees, accounting for 35.71%; May to August 2019 was the rapidly rising stage, with 170 most late vaccinees, accounting for 37.95%; September 2019 to the end of the survey was the standstill stage, with 51 laggards, accounting for 11.38%. All of the leaders had participated in cervical cancer screening, voluntarily vaccinated, and knew the susceptible population of cervical cancer, the targeted HPV types and the suitable population of vaccine. The median age of the first pregnancy was 27 years old. Six of them had three pregnancies. The early vaccinees and the most early vaccinees were recommended by doctors or friends to get HPV vaccine. The median age of first pregnancy was 26 and 28 years old, respectively. Their other characteristics were similar to those of the leaders. The characteristics of most late vaccinees were similar to those of the laggards. They were were mainly students who were recommended by their friends to receive HPV vaccination, did not participate in cervical cancer screening, did not know the susceptible population of cervical cancer, the targeted HPV types and the suitable population of vaccine.@*Conclusions@#People with high risk of HPV exposure, awareness of cervical cancer and screening are more likely to receive HPV vaccination at the early stage. It is necessary to strengthen the health education of HPV vaccination, and make full use of the influence of doctors and early vaccinees, which is helpful to promote the early vaccination of HPV vaccine among the right age population.

Utilization Evaluation of Human Papilloma Virus Vaccine (GARDASIL®) in Iran; A Cross-Sectional Study.

Vaccination against HPV seems to be a good approach for prevention of cervical cancer and genital warts. But in Iran we are confronted with lack of evidence for its cost-effectiveness whereas its consumption is dramatically increasing. This was a cross- sectional study. We used a questionnaire including 5 sections as follows; Patients demographic information, Patients medical history, Pregnancy and lactation considerations, Gardasil prescription characteristics and HPV infection characteristics. Prescriber with adherence to guideline were defined as those prescribing Gardasil for correct age range and indication with accurate dosage and administration. Descriptive statistics for variables was shown by frequency (percent) or mean (± SD) and evaluation of relation between categorical variables was performed by using Chi-square test. Total 566 Gardasil recipients participated in the study. There were mostly female with mean age of 28.1 (± 6.68). For 128 (22.6%) participants Gardasil prescribed correctly considering both age range (9-26 years) and indication (prophylactic). From this group, 80 participants (14.1%/566) have received accurate Gardasil dosage and interval (prescriber had adherence to guideline). Patients' out of pocket payment in guidelines adherent prescriptions was a seventh of total costs obtained from 566 consumers. Gynecologists significantly prescribed for prophylaxis higher than other specialties (p-value = 0.01). Prescribers' practice in administrating Gardasil is obviously not appropriate and it is imposing burdensome cost to community and government. On the other hand, we have encountered with increasing rate of its use in Iran in past years. Therefore, we are in urgent need for appropriate interventions in national level and prompt supervision to regulate Gardasil consumption.

[Research status of human papillomavirus vaccine for prevention and treatment of respiratory papillomatosis].

Recurrent respiratory papilloma (RRP) is closely related to human papillomavirus (HPV) infection and is the main pathogenic factor. At present, HPV vaccine injection is a new method to control RRP, and its efficacy has been confirmed by many clinical trials. The development and application of HPV vaccine is bound to bring new development to the treatment of RRP. This article reviews the status of HPV vaccine in clinical RRP treatment.