青春前期女性接种人乳头瘤病毒疫苗专家共识

人乳头瘤病毒（HPV）疫苗接种是子宫颈癌防控的重要措施之一。通过综合考虑HPV疫苗接种的有效性、安全性、成本效益等多方面因素,专家强烈推荐青春前期（9~14岁）女性作为重点目标人群应优先接种HPV疫苗,提高重点目标人群HPV疫苗免疫覆盖率,以达到子宫颈癌一级预防策略的最佳效果。     

人乳头瘤病毒疫苗安全性研究的新进展

人乳头瘤病毒(HPV)的持续感染是导致子宫颈癌的主要致病因素,全球每年约63万例新发癌症由HPV感染所致,其中子宫颈癌占比最高,达83%。中国子宫颈癌的疾病负担严重,研究数据显示,2018年中国子宫颈癌新发病例近11万,死亡病例近5万,分别约占全球发病和死亡总数的20%和16%。世界卫生组织(WHO)的立场文件中明确指出,HPV疫苗的接种可有效预防HPV相关疾病的发生。纵观全球的临床研究及真实世界数据,HPV疫苗显示出良好的保护效力及安全性。截至2019年10月,全球已有98个国家和地区将HPV疫苗纳入国家免疫计划。然而,伴随接种范围的增加及适应证的扩大,HPV疫苗的安全性成为了全球高度关注的公共卫生问题。自2006年HPV疫苗上市以来,各国多家权威机构均对HPV疫苗上市后的安全性进行长期监测,积累了大量的安全性数据,数据显示HPV疫苗安全性良好并支持HPV疫苗的使用。本文将针对全球及中国大陆的HPV疫苗相关的安全性数据进行梳理,为中国HPV疫苗的接种提供参考。     

人乳头瘤病毒疫苗接种意愿及影响因素

宫颈癌与人乳头瘤病毒（human papillomavirus,HPV）感染密切相关，阻断HPV感染是预防宫颈癌及相关疾病的关键。HPV疫苗的推广使用，有效降低了宫颈癌及相关疾病的发生率。本文系统梳理了国内外有关HPV疫苗的接种意愿及影响因素，为提高HPV疫苗的接种率，预防宫颈癌及相关疾病提供参考。     

青少年女性人乳头瘤病毒疫苗免疫策略与实践长三角地区专家共识

高危型别的人乳头瘤病毒(HPV)持续感染是发生子宫颈癌的主要原因。为实现消除子宫颈癌的目标, WHO提出"90-70-90"的战略目标, 其中之一即是"90%的女孩在15岁之前完成HPV疫苗接种"。基于HPV感染的流行病学特征和HPV疫苗的特性, 优先保障青少年女性接种HPV疫苗至关重要。中国疫苗行业协会免疫规划规范化管理与实践分会组织专家组制定了《青少年女性人乳头瘤病毒疫苗免疫策略与实践长三角地区专家共识》。本共识依据国内外关于青少年接种HPV疫苗的最新研究进展, 结合我国长三角地区的人群特征、HPV感染和子宫颈癌的流行特点, 介绍了HPV感染及相关疾病负担、青少年女性接种HPV疫苗的安全性和有效性、影响青少年女性接种HPV疫苗健康获益的因素、现有青少年女性HPV疫苗接种策略、长三角地区青少年女性接种HPV疫苗的专家建议及常见问题和注意事项等内容, 旨在指导长三角地区青少年女性HPV疫苗接种, 并为其他地区提供借鉴。     

山西某县农村女性人乳头瘤病毒及其疫苗认知情况的调查分析

我国子宫颈癌疾病负担沉重,目前尚无系统的子宫颈癌防治计划,近年来部分地区呈现年轻病例增多的现象。人乳头瘤病毒（HPV）预防性疫苗接种被证明可以有效预防HPV感染,并能减少70％左右的宫颈癌发生,为宫颈癌的预防提供了新的前景和方向。本研究欲了解山西某县农村女性对HPV的认知情况及对HPV疫苗的接受意愿,分析该疫苗在中国农村地区推广应用的潜在障碍、探索可能的解决方案,为我国人群宫颈癌的一级预防提供参考资料。     

中山大学本科生对HPV及疫苗认知的调查

摘要:目的　了解中山大学本科学生对HPV及其预防性疫苗认知情况,分析其影响因素,为HPV疫苗在国内推广提供建议。方法　采用分层整群抽样方法,获得中山大学本科学生共2 004名。调查方式为问卷自填式。内容包括基本情况及人口统计学特征、对HPV疫苗和相关疾病的认知情况以及HPV疫苗接种的意愿。结果　2 004名本科生中,有261人（13.1%）听说过HPV疫苗,听说过HPV相关疾病的有1 649人（82.9%）,有80.2%和79.7%的人愿意自己接种疫苗和鼓励男/女朋友接种疫苗。年级和专业是影响是否听说HPV疫苗的因素,是否听说HPV相关疾病、是否担心患HPV相关疾病是影响接种疫苗意愿因素。结论　大学本科学生对HPV疫苗以及相关疾病的认识欠缺全面,接种疫苗的意愿积极。学校推进HPV疫苗以及相关专业知识在本科阶段的教育,国家增加对HPV疫苗的补贴,有利于HPV疫苗的推广。     

青海高海拔地区女性对HPV和HPV疫苗的认知情况

目的了解高海拔欠发达地区部分女性对人乳头瘤病毒(HPV)和HPV疫苗的认知情况,以及主要影响接种HPV疫苗的因素,为更好地开展HPV疫苗接种、预防子宫颈癌的发生提供参考依据。方法于2019年1—11月选取青海西宁和玉树州的206例女性进行问卷调查,收集资料,了解其对HPV以及HPV疫苗的认知情况,并对影响调查对象认知的主要因素进行分析。结果206例调查者中,66.50%的女性听说过HPV,13.11%的女性没有听说过;52.43%的女性听说过HPV疫苗;43.20%的女性没有听说过HPV疫苗。结论高海拔地区部分女性对HPV知识及HPV疫苗的知晓率偏低,这与地区差异、文化程度、经济状况等均是影响因素。应加强宣传指导,普及相关知识,提高子宫颈癌的一级预防,降低子宫颈癌患病率。     

新疆生产建设兵团地区人乳头瘤病毒亚型与子宫颈癌关系及影响因素

目的 了解新疆生产建设兵团地区人乳头瘤病毒（human papilloma virus,HPV）基因型分布与子宫颈癌分布情况，为子宫颈癌筛查工作提供科学参考。方法 2019—2020年对新疆生产建设兵团7个师常驻人口（≥6个月）的35～64岁女性开展子宫颈癌筛查。结合HPV亚型感染与混合感染情况，分析与不同程度癌变的关系。结果 本研究最终纳入100 525人，HPV检测阳性9 533例，阳性率9.48%，子宫颈癌397例，患病率0.39%。HPV阳性率在地区、民族、年龄和文化水平差异有统计学意义（P<0.05），子宫颈癌患病率在地区、民族、文化水平差异有统计学意义（P<0.05）。HPV感染以HPV16 (1.50%)、HPV52 (1.60%)、HPV58 (1.30%)、HPV53 (0.90%)、低危型（1.60%）为主，子宫颈癌（≥CINⅠ）的主要HPV亚型有HPV16 (0.25%)、HPV18 (0.04%)、HPV52 (0.04%)、HPV58 (0.04%)、低危型（0.04%）、HPV53 (0.02%)为主。高危型HPV可导致不同程度子宫颈癌前病变，H...     

女人与宫颈癌的误会

误解1：宫颈癌不能预防 事实：感染了人乳头状瘤病毒（HPV）是形成子宫颈癌必须的条件。这种病毒通过性传播，但大多数感染类型都能通过最新的疫苗来预防。避免HPV感染明显减少了妇女的宫颈癌危险。而且通常持续感染HPV后，子宫颈癌缓慢发展，并以被称为不典型增生的癌前期病变出现，如果在这个阶段被发现，     

TCT＋HPV联合检测早期宫颈病变的临床观察

子宫颈癌是威胁女性生命的主要疾病之一，子宫颈癌的病死率居女性各系统恶性肿瘤的第三位，居女性生殖系统恶性肿瘤的第二位，仅仅次于乳腺癌。随着子宫颈癌筛查的普及，其发病率和病死率均有明显下降，成为肿瘤防治工作的典范。近年来，TCT＋HPV（液基薄层细胞学＋人乳头瘤病毒）联合检测是最有效的子宫颈癌筛查手段，同时高危型HPV—DNA检测对细胞学结果为不典型鳞状上皮细胞（ASCUS）的有分流检测的临床价值。     

Knowledge and Awareness of Parents Towards Human Papillomavirus (HPV) and HPV Vaccines,and Vaccine Acceptability in Northern Cyprus

Journal of Prevention - The human papillomavirus (HPV) vaccine is one of the most cost-effective public health measures for preventing cervical cancer and other HPV-related diseases. However, the...     

长治市医学和非医学大学生HPV疫苗相关知识现况调查

目的探讨大学生对宫颈癌疾病相关知识及预防性HPV疫苗的认知现状,为学校进行宫颈癌及HPV病毒相关健康教育提供理论依据,为预防性HPV疫苗的推广接种和宫颈癌的防治提供参考资料。方法以长治地区高校大学生为研究对象;采取自行设计的电子问卷,于2018年3-9月组织在校大学生进行在线问卷调查。结果共收回570份问卷,有效问卷552份,有效率96. 84%。其中23. 73%(131/552)的学生了解宫颈癌发病时主要的临床表现,28. 09%(160/552)的学生知道诱发宫颈癌的最常见HPV高危型别,仅有17. 39%(96/552)的学生认为二价与四价预防性HPV疫苗对于预防宫颈癌的效果是相当的。结论应加强大学生关于宫颈癌疾病及预防性HPV疫苗相关知识的全面、系统宣教,健康教育的重点可放在关于HPV疫苗有效性、安全性及接种相关知识背景等方面,可一定程度上对宫颈癌疾病的防控和HPV疫苗的接种推广起到积极作用。     

Economic burden of HPV-related cancers in France

Human papillomavirus (HPV) infection is associated with a range of diseases and cancers at different anatomical sites. In addition to its role as a necessary cause of cervical cancer, HPV is also associated with cancers of the vulva, vagina, anus, penis, head and neck. With the exception of cervical cancer, however, very few data are available on the economic burden of HPV-associated cancers. We assessed the annual costs associated with management of HPV-related cancers in France from the healthcare payers’ perspective. We used data from studies that employed similar methodologies to estimate the costs during 2006 for cervical cancer, vulvar and vaginal cancers, anal cancer, and penile cancer, and during 2007 for head and neck cancers. Data on hospital-management costs for cancer were derived from the French national hospital database. The costs of outpatient care and daily allowance costs were estimated using data from the French National Institute of Cancer report for 2007. The costs for HPV-related cancers were estimated according to the percentage of each cancer type attributable to HPV infection. The estimated total costs associated with HPV-related cancers in France were €239.7 million. The overall costs in men were €107.2 million, driven mainly by head and neck cancers (€94.6 million). The total costs in women were €132.5 million, due mainly to invasive cervical cancer (€83.9 million). The costs associated with HPV-related cancers are important to consider when evaluating the overall benefits of HPV vaccination in males and females.     

中国人乳头瘤病毒感染相关疾病经济负担:系统文献回顾和综合分析

  目的  整合中国内地人乳头瘤病毒(human papilloma virus, HPV)感染相关疾病的成本相关数据,估算中国内地HPV感染相关疾病的经济负担。  方法  以“成本/费用”分别联合HPV感染相关9种疾病即宫颈癌、阴道癌、外阴癌、肛门癌、阴茎癌、口咽部癌、宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)、肛门生殖器疣(anogenital warts,AGW)和复发性呼吸道乳头状瘤(recurrent respiratory papillomatosis,RRP)的名称为关键词,检索PubMed、中国知网等7个数据库2001―2020年发表的针对中国内地患者的文献,摘取各类成本相关数据,并将成本数据按照相应的消费价格指数逐年调整至2020年,估算这9种疾病各自的例均直接医疗成本、直接非医疗成本和间接成本。收集这9种疾病各自的发病率、患病率和HPV归因分数数据,进一步估算2020年中国内地HPV感染相关疾病总经济负担。  结果  最终纳入文献247篇。6种恶性肿瘤的首年例均总成本为58 189~79 567元,随后年年例均总成本为13 025~27 965元。RRP的年例均总成本为41 329元。CIN和AGW的例均总成本为6 452~13 602元。2020年中国内地HPV感染相关疾病所致总经济负担为180.3亿元,其中宫颈癌为96.9亿元。直接医疗成本是经济负担的主要部分,占总成本的70%,其中宫颈癌的直接医疗成本为70.0亿元。  结论  HPV感染相关疾病每年给中国内地造成的经济负担不容忽视,需扩大HPV疫苗接种以减少其经济损失。     

Burden of HPV-caused cancers in Denmark and the potential effect of HPV-vaccination

BackgroundDenmark is one of the countries where Human papillomavirus (HPV)-vaccination at present includes only girls. However, the burden of HPV-related cancer in men is increasing, which would argue for gender-neutral vaccination. The aim of this study was to examine the burden of HPV-caused cancers in women and men, and to evaluate the potential of HPV-vaccination in cancer control.MethodsData were retrieved from the literature on population prevalence of high risk (HR) HPV, on HR HPV-prevalence and genotypes in HPV-related cancers, and on number of cytology samples in cervical screening. Data on annual biopsies and conisations were retrieved from the Danish National Health Service Register and the Danish National Patient Register. Incidences of HPV-related cancers in Denmark were extracted from NORDCAN. Number of HPV-caused cancers was calculated from number of HPV-related cancers and the proportion known to be caused by high-risk (HR) HPV.ResultsIn cross-sectional surveys in Denmark, one fifth of women and almost one third of men were found to be positive for HR HPV. Per year, 548 HPV-caused cancer cases were diagnosed in women and 234 in men, and twice as many cancers in women as in men were preventable with HPV vaccination. However, including screening prevented cervical cancers, the burden of cancers caused by HPV-infection would be 1300–2000 in women as compared to 234 in men.ConclusionTaking screening prevented cervical cancers into account, the cancer control potential of HPV-vaccination is considerably higher in women than in men. HPV-vaccination could reduce the burden of screening on women and on health care resources.     

The economic burden of human papillomavirus infection-associated diseases in the Republic of Korea, 2002–2015

BackgroundThis prevalence-based, cost-of-illness study estimated the health care costs of human papillomavirus (HPV) infection-associated diseases in the era before the introduction of organized HPV vaccination for 12-year-old girls in 2016, South Korea.MethodsThe claims data provided by the National Health Insurance Service was used to estimate the prevalence of HPV-associated diseases and their direct medical costs, including costs related to hospitalizations, outpatient visits, and medications.ResultsA total of 1.3 million men and women used medical services for HPV-attributed diseases between 2002 and 2015. Among women, the most common diseases attributable to HPV were cervical dysplasia (64.4%), anogenital warts (12.9%), cervical carcinoma in situ (10.7%) and cervical cancer (2.6%), whereas anogenital warts (80.6%), benign neoplasms of larynx (14.3%), and anal cancers (8.9%) were most common among men. In 2015, the healthcare cost attributable to HPV was 124.9 million US dollars (USD) representing 69.0% of the annual cost of all HPV-associated diseases. At a cost of 75.1 million USD, cervical cancer contributed the largest economic burden in 2015 followed by cervical dysplasia (19.4 million USD) and cervical carcinoma in situ (10.7 million USD). These three conditions represented 58.2% of the total annual cost of all HPV-associated diseases, while 84.2% of the total annual cost was attributable to HPV. Annual health care costs increased from 42.6 million USD in 2002 to 180.9 million USD in 2015.ConclusionThe healthcare costs associated with HPV-related diseases in Korea are substantial and increased between 2002 and 2015 mainly caused by increased number of patients. Expanding the target age for HPV vaccination of girls and introducing HPV vaccination for boys are possible ways of reducing the economic burden of HPV-associated disease and should be considered.     

Progress toward implementation of human papillomavirus vaccination--the Americas, 2006-2010

Cervical cancer is a major cause of morbidity and mortality in the Americas, where an estimated 80,574 new cases and 36,058 deaths were reported in 2008, with 85% of this burden occurring in Latin America and the Caribbean. Two oncogenic human papillomavirus (HPV) types (16 and 18) cause approximately 70% of cervical cancers and a substantial proportion of other HPV-related cancers. HPV vaccination provides an opportunity to greatly reduce cervical cancer burden through primary prevention of HPV infection. This report summarizes the progress toward HPV vaccine introduction in the Americas, focusing on countries that have introduced the vaccine in national or regional immunization programs. As of January 2011, four countries in the Americas had introduced HPV vaccine. Overcoming issues related to financing and delivery of HPV vaccine remains a key public health challenge to more widespread implementation of HPV vaccination in the Americas.     

Prophylactic HPV vaccines: reducing the burden of HPV-related diseases

HPV-associated diseases, such as cervical and other anogenital cancers, cervical and anal intraepithelial neoplasia, genital warts, and recurrent respiratory papillomatosis confer considerable morbidity and mortality, and are significant health care concerns. Successful vaccination strategies that protect against HPV infection are expected to substantially reduce HPV-related disease burden. Prophylactic HPV vaccines in late stages of clinical testing are composed of HPV L1 capsid protein that self-assemble into virus-like particles (VLPs) when expressed in recombinant systems. Proof-of-principle trials have suggested that intramuscular injections of VLPs results in strong adaptive immune responses, both B- and T-cell mediated, that are capable of neutralizing subsequent natural infections. Furthermore, phase 2 trials of a bivalent vaccine designed to protect against high-risk HPV types 16 and 18 and a quadrivalent vaccine designed to protect against HPV 16 and 18, and low-risk, genital wart-causing HPV 6 and 11 have demonstrated that VLP vaccines reduce the incidence of HPV-associated disease in vaccinated individuals. To derive the greatest public health benefit, HPV vaccines offering protection from cervical cancer and genital warts will, ideally, be administered prior to the initiation of sexual activity; therefore, educational initiatives will be essential to communicate the risks and adverse consequences of HPV infection and to foster widespread vaccine acceptance.     

健康教育对四川省医务人员HPV及其疫苗认知及态度的影响

目的 了解健康教育对四川省医务人员HPV相关知识的认知情况及对HPV疫苗接种态度的影响,为HPV疫苗在四川省的进一步推广提供参考依据。方法 对2018 - 2019年在四川省参加全国宫颈癌预防医师培训项目的医务人员进行培训前后的问卷调查。调查对象培训前后对HPV相关知识认知情况及对HPV疫苗态度的差异性比较采用χ2检验。是否愿意主动推荐HPV疫苗人群中,HPV相关知识平均得分差异性比较采用t检验。结果 培训前、后有效问卷分别为485、459份。培训后,医务人员对HPV及其疫苗相关知识知晓率有不同程度提高。认为HPV疫苗安全(χ2 = 27.881,P＜0.001)、有效(χ2 = 24.943,P＜0.001)以及愿意主动推荐HPV疫苗(χ2 = 24.010,P＜0.001)的医务人员占比与培训前相比均有提升。培训前(t = 5.328,P＜0.001)及培训后(t = 3.090,P＜0.05)愿意主动推荐疫苗组的HPV相关知识平均分均高于不愿意主动推荐疫苗组。医务人员不愿意主动推荐HPV疫苗的原因主要为对相关知识的了解不够(31.5%)、价格过高(22.6%)以及对疫苗的有效性及安全性存疑(22.6%)。结论 应在医务人员中开展形式多样的健康教育以提高其HPV相关知识水平及HPV疫苗推广态度,从而提高人们对HPV疫苗的接受度,为宫颈癌的一级预防提供人群基础。