RESUMEN
Background: Current National Advisory Committee on Immunization (NACI) guidance recommends human papillomavirus (HPV) vaccines be administered as a two or three-dose schedule. Recently, several large clinical trials have reported the clinical benefit of a single HPV vaccine dose. As a result, the World Health Organization released updated guidance on HPV vaccines in 2022, recommending a two-dose schedule for individuals aged 9-20 years, and acknowledging the use of an alternative off-label single dose schedule. Objective: The objective of this overview is to provide a detailed account of the available evidence comparing HPV vaccination schedules, which was considered by NACI when updating recommendations on HPV vaccines. Methods: To identify relevant evidence, existing systematic reviews were leveraged where possible. Individual studies were critically appraised, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence. Results: Available evidence suggests that a one, two, or three-dose HPV vaccine schedule may provide similar protection from HPV infection. While antibody levels against HPV vaccine types were statistically significantly lower with a single dose schedule compared to two or three doses, titres were sustained for up to 16 years. The clinical significance of lower antibody titres is unknown, as there is no established immunologic correlate of protection. Conclusion: While the available evidence on single-dose HPV vaccination schedules shows a one-dose schedule is highly effective, continued follow-up of single-dose cohorts will be critical to understanding the relative duration of protection for reduced dose schedules and informing future NACI guidance on HPV vaccines.
RESUMEN
OBJECTIVE: To determine the prevalence of symptoms and risk of obstructive sleep apnea (OSA) among patients with ruptured cerebral aneurysms. METHODS: In this case-control study, a validated Arabic version of the Berlin Questionnaire (BQ) was administered to patients admitted to King Fahd Medical City, Riyadh, Saudi Arabia with cerebral aneurysms between January 2006 and July 2011 (n=53). The same questionnaire was administered to a control group comprised of patients attending primary health care clinics who were matched for age, body mass index (BMI), and gender (n=212). RESULTS: The mean age of patients with ruptured cerebral aneurysms was 50.7 +/- 15.2 years, and the mean BMI was 27.9 +/- 4.8 kg/m2. In this group, 75.5% complained of snoring compared with 46.7% of the controls (p=0.000). Hypertension was present in 67.9% of cases compared with 30.2% of the controls (p=0.000). Based on the BQ scores, 60.4% of the cases were considered to be at high risk for OSA compared with 31.6% of the controls (p=0.000). CONCLUSION: The prevalence of OSA symptoms among patients with ruptured cerebral aneurysms is very high. Almost 60% of patients with ruptured cerebral aneurysms are at risk for OSA.
