四价人乳头瘤病毒疫苗预防中国大陆女性HPV持续感染及下生殖道相关疾病的保护效力:一项随访78个月的随机对照研究

目的探讨20～45岁中国大陆女性首次接种四价人乳头瘤病毒(HPV)疫苗(简称"四价HPV疫苗",含HPV6/11/16/18)后长达6.5年的保护效力。方法采取随机、双盲、安慰剂对照、多中心的临床试验设计,将3 006名20～45岁中国大陆女性按1:1随机分组(疫苗组与对照组各1 503名),分别于第1天、第2个月和第6个月接种3剂四价HPV疫苗或安慰剂(仅含无定形羟基磷酸铝硫酸盐)。收集宫颈、阴唇、会阴及肛周脱落细胞,并进行HPV检测和妇科检查,在接种的第1天、第7、12、18、24、30、42、54、66和78个月进行宫颈细胞学检查。宫颈细胞学异常(ASCUS和HPV阳性、LSIL及以上者)进行阴道镜检查和宫颈活检。评估HPV相关生殖器疾病、持续感染及复合终点[包括HPV6/11/16/18相关的HPV的持续感染、宫颈上皮内瘤变(CIN)及以上病变(CIN+),子宫颈癌前病变、原位腺癌(AIS)、子宫颈癌)及外生殖器病变]的发生状况。结果 3 006名女性中,2 759名(91.8%)女性(疫苗组1 401名,对照组1 358名)和2 374名(79%)女性(疫苗组1 199名,对照组1 175名)分别完成了30个月和78个月的随访。在第78个月,在20～45岁符合保护效力方案(PPE)女性中,四价HPV疫苗对HPV16/18相关的CIN2+(CIN2或CIN3、AIS和宫颈癌)的保护效力为100%(95%CI:32.3%～100%),对HPV6/11/16/18相关的CIN 1+(CIN 1/2/3、AIS和宫颈癌)保护效力为100%(95%CI:70.9%～100%)。在PPE女性中,随访至30个月时,四价HPV疫苗对HPV 6个月持续感染的保护效力为91.6% (95%CI:66.0%～99.0%);随访至78个月时,四价HPV疫苗对HPV 12个月持续感染的保护效力为97.5%(95%CI:85.1%～99.9%)。四价HPV疫苗对HPV6/11/16/18相关的宫颈细胞学异常率的保护效力为94.0%(95%CI:81.5%～98.8%)。结论四价HPV疫苗在预防中国大陆20～45岁女性HPV持续感染及下生殖器癌前病变的保护效力良好。     

妊娠早期接种新型冠状病毒灭活疫苗后的急性不良事件及妊娠结局

目的探讨妊娠早期接种新型冠状病毒灭活疫苗后的急性不良事件及妊娠结局。方法采用回顾-前瞻性队列研究方法。选取2021年5月至11月在社区医院建围产保健卡后、孕11～13周+6于连云港市妇幼保健院产科门诊规范产前检查、符合纳入标准的孕妇作为研究对象。根据妊娠早期疫苗接种情况, 将其分为接种组和未接种组, 接种组进一步分为接种1剂组和接种2剂组。收集所有孕妇妊娠期相关筛查、妊娠期并发症、妊娠结局及急性不良事件的发生情况, 采用独立样本t检验或方差分析、Kruskal-WallisH检验或Mann-WhitneyU检验、χ2检验或Fisher精确概率法进行统计分析。结果最终纳入接种1剂组孕妇105例, 接种2剂组90例, 未接种组194例。(1)3组孕妇急性不良事件的发生[接种1剂组:2.86%(3/105);接种2剂组:6.67%(6/90);未接种组:4.63%(9/194);χ2=1.59。接种组为4.61%(9/195), 与未接种组比较, χ2=0.00]、妊娠期相关筛查指标的异常情况、各项妊娠结局比较, 差异均无统计学意义(P值均>0.05);接种组(接种1剂+接种2剂)与未...     

河北丰宁地区妇女人乳头瘤病毒感染及疫苗认知状况调查

目的调查河北省丰宁满族自治县妇女人乳头瘤病毒（HPV）感染及对宫颈癌、HPV和HPV疫苗的认知情况,并探讨宣教对其认知度的影响。方法对河北丰宁地区717例18~45岁妇女进行HPV相关知识的问卷调查及宣教,对其中647例妇女留取宫颈脱落细胞进行高危型HPV DNA检测。结果高危型HPV总检出率为16.07%（104/647）;14.78%（106/717）的妇女曾听说过HPV,HPV知晓率与年龄、婚姻情况、户口类型及教育程度有关（P〈0.05）;84.38%（605/717）的妇女从未行宫颈癌筛查,在112例行宫颈癌筛查的妇女中,末次筛查为巴氏涂片、宫颈液基细胞学和HPV检测者分别为16.07%（18/112）、39.29%（44/112）和8.04%（9/112）;宣教后HPV知晓率显著提高（P〈0.05）;15.76%（113/717）的妇女既往听说过HPV疫苗,75.59%（542/717）的妇女倾向于接种医疗机构提供的疫苗,24.41%（175/717）的妇女倾向于接种政府或医药公司提供的疫苗。结论河北丰宁地区妇女HPV现患率较高,对HPV及宫颈癌的认知率偏低,宣教后人群认知程度显著提高,因此公众教育可以显著提高人群对HPV疫苗相关知识的认知水平。     

关于儿童预防接种后不良反应的临床案例分析

预防接种疫苗,可使人体产生抗体(抵抗力),是控制、消除、消灭相应传染病的有效措施。通过190多年接种牛痘苗,人类终于消灭了天花,是人工免疫取得的光辉范例。现已通过口服脊髓灰质炎减毒活疫苗来消灭小儿麻痹症。消灭脊灰已指日可望。但由于预防接种所使用的生物制品,采用减毒、弱毒的病毒(苗)制成活疫苗,或用化学、物理的方法杀灭的微生物制备的死疫苗,对人体而言均是异性蛋白,使用及当今发生一些正常的或异常的全身及局部反应。现用的疫苗都按国家制定的规程生产,是安全有效的、反应轻微。本文对计划免疫所使用的卡介苗,百日咳菌苗,白喉破伤风类毒素三联混合制剂,乙脑疫苗,流脑等法定疫苗的不良反应做以简述。全社区2010年共报告接种预防性生物制品260剂次,其中9类制品报告了38例不良反应,不良反应平均发生率为14.62%剂次。百白破疫苗不良反应发生数最多,占总例数的32.57%。38例不良反应中,≤1岁婴儿发生的不良反应例数最多占68.42%,71.05%的不良反应发生在接种疫苗24h内。同类疫苗不同剂次不同工艺不良反应发生率不同,第一剂乙脑和流脑疫苗明显高于其他剂次,全细胞百白破疫苗(DTwP)高于无细胞百白破疫苗(DTaP)。结论:选用免疫效果好且安全性高的预防性生物制品,加强预防接种人员规范化操作,严格掌握禁忌证并做好预检筛查,从而减少预防接种后不良事件的发生。     

HPV16E7肽疫苗对人免疫重建荷人宫颈癌细胞株SiHa细胞SCID鼠免疫功能的影响

目的:观察HPV16E7多肽疫苗对人免疫重建荷人宫颈癌细胞株SiHa细胞严重联合免疫缺陷(SCID)鼠移植瘤的影响。方法:对SCID鼠腹腔注射人外周血淋巴细胞(PBL)后24小时,皮下接种HPV16阳性的人宫颈癌细胞株SiHa细胞,建立人免疫重建荷SiHa细胞的SCID鼠模型,当移植瘤最小体积达100mm3时,三次背部皮下接种疫苗,每次接种间隔二周,观察荷瘤鼠一般生物学特性,检测血浆中人IgG含量、外周血中人CD3+、CD4+、CD8+T细胞、脾重、肿瘤浸润淋巴细胞(TIL)以及脾细胞毒杀伤功能。实验设立空白组,仅为腹腔内注射PBL,疫苗成份仅为不完全佐剂(IFA);随机多肽组,为腹腔内注射PBL,皮下接种SiHa细胞,疫苗成份仅为随机多肽+T辅助多肽+IFA;T辅助多肽组,为腹腔内注射PBL,皮下接种SiHa细胞,疫苗成份仅为T辅助多肽+IFA;多肽治疗组,为腹腔内注射PBL,皮下接种SiHa细胞,疫苗成份为HPV16E711-20(YMLDLQ-PETT),HPV16E786-93(TLGIVCPI)+T辅助多肽+IFA。结果:各组SCID鼠血浆中人IgG水平,8周内随重建时间延长而升高(P<0.05),多肽治疗组达2957.85μg/m l,但各组间无显著性差异;外周血中均可检测到人CD3+、CD4+、CD8+T细胞,但各组间无显著性差异(P>0.05);与空白组比较,其他三组SCID鼠脾重均显著增加(P<0.05)。组织学观察到移植瘤局部TIL浸润及明显的出血和坏死,但经免疫组化未检测到人CD8+T细胞。与空白组比较,多肽治疗组、随机多肽组、辅助多肽组的脾细胞毒杀伤功能均显著降低(P<0.05)。结论:人免疫功能重建的荷SiHa细胞的SCID鼠体内重建的人免疫功能随荷瘤时间的延长受到抑制,多肽疫苗在一定程度上能减轻免疫抑制状态。     

母源性抗乙型肝炎病毒表面抗原抗体对婴儿乙型肝炎疫苗接种的影响

目的 了解母源性抗乙型肝炎病毒表面抗原抗体(anti-hepatitis B surface antigen antibody,抗-HBs抗体)对婴儿乙型肝炎疫苗接种后抗体应答的影响.方法 2006年10月至2007年1月在南京大学医学院附属鼓楼医院产前检查并住院分娩的单胎足月妊娠妇女中,选择抗-HBs抗体阳性孕妇43例(阳性组)和阴性孕妇29例(阴性组),其足月儿出生时和出生后1个月分别接种乙型肝炎疫苗.定量检测孕妇分娩前、脐动脉血及婴儿1月龄和3.5月龄的抗-HBs抗体水平.结果 阳性组43例新生儿脐血抗-HBs抗体也为阳性,与母血清抗体水平的相关系数r=0.98(t=39.05,P<0.01);1月龄时,42例抗体仍阳性.阴性组29例新生儿脐血和1月龄时抗-HBs抗体均阴性.3.5月龄时,两组抗-HBs抗体阳性率均为100%,但阴性组平均抗-HBs抗体浓度高于阳性组[(466.9±86.7)mIU/ml和(151.2±23.1)mIU/ml,t=2.72,P=0.011].母源性抗-HBs抗体>1000 mIU/ml的5例婴儿中,3例在接种2次疫苗后没有产生主动抗体应答.结论 母源性抗-HBs抗体可抑制乙型肝炎疫苗前2次接种后的抗体应答.     

孕妇HBsAg阳性对新生儿初次免疫后三年内乙肝表面抗体稳定性的影响

目的 探讨孕妇HBsAg阳性对其新生儿出生后3年内乙肝表面抗体(HBsAb)稳定性的影响,观察定期检查和及时加强/重复免疫对维持儿童乙肝疫苗免疫效果的作用.方法 对20例HBsAg阴性孕妇及24例HBsAg阳性孕妇分娩的新生儿初次全程乙型肝炎基因疫苗免疫效果进行3年的随访,对儿童中有HBsAb滴度下降至低于保护性滴度或转阴者(即不稳定者)及时复种,比较两组儿童HBsAh不稳定者所占比例,比较初次免疫后1个月及3岁时HBsAb的阳性率.结果 孕妇HBsAg阴性及孕妇HBsAg阳性两组儿童HBsAb不稳定者所占比例分别为[20.0%(4/20)和79.2%(19/24,),P<0.05];两组HBsAb阳性率在7月龄时分别为100.0%(20/20)和62.5%(15/24)(P<0.05),3岁时分别为85.0%(17/20)、91.7%(22/24)(P>0.05).结论 孕妇HBsAg阳性将降低其新生儿初次全程免疫后3年内HBsAb稳定性,通过每间隔半年至一年的定期检查和及时加强/重复免疫可维持乙肝疫苗免疫效果.     

人乳头状瘤病毒16型多肽疫苗的制备及体内外效应观察

目的 探讨人乳头状瘤病毒(HPV)16型多肽疫苗的制备,并观察HPV16多肽疫苗的体内外效应.方法 (1)针对抗原加工相关转运子(TAP)设计HPV16 E7蛋白的主要组织相容性复合物Ⅰ类分子(MHC-I)的抗原结合表位,利用生物信息学分析平台筛选出一致性较高、特异性及亲和力较强的HPV16 E7多肽作为研究对象制备HPV16多肽疫苗用于以下研究,本研究共筛选出3段多肽,分别命名为E7Pa、E7Pb、E7Pc.(2)C57BL/6小鼠注射鼠肺上皮细胞株TC-1细胞(为鼠源性的HPV16阳性的肿瘤细胞株)后,采用等额抽取的随机方法分为5组,ETPa+二核苷胞嘧啶(CpG)、E7Pb+CpG、E7Pc+CpG[均为实验组,分别加入终浓度为50μg/ml的E7Pa、E7Pb、E7Pc和终浓度为12 mg/L的刀豆蛋白(ConA)]、CpG(为阳性对照,加入终浓度为12 mg/L 的Con A)和空白对照组(不做任何处理).采用四甲基偶氮唑蓝(MTT)比色法检测各组作用不同时间后小鼠脾T淋巴细胞的体外增殖效应,乳酸脱氢酶(LDH)释放法检测小鼠脾T淋巴细胞在不同效靶比下的体外细胞毒T淋巴细胞(CTL)活性,实时荧光定量RT-PER技术检测小鼠肿瘤组织中γ干扰素(IFN-γ)、白细胞介素2(IL-2)mRNA的表达水平,酶联免疫吸附试验(ELISA)检测小鼠外周血中IFN-γ、IL-2的表达水平,通过定期测量比较各组小鼠接种HPV16多肽疫苗后体内肿瘤体积的变化.结果 (1)本研究筛选出了一致性较高、特异性及亲和力较强的3段HPV16 E7多肽作为研究对象制备HPV16多肽疫苗,分别命名为E7Pa、E7Pb、E7Pc.(2)MTT比色法检测显示,在接种疫苗24、48、72、96 h后,以E7Pa+CpG组的增殖效应最明显,其细胞增殖率分别为(131±32)%、(302±15)%、(552±28)%、(731±24)%,明显高于空白对照组的(72±15)%、(120±57)%、(176±41)%、(288±29)%(P<0.01);E7Pb+CpG、ETPc+CpG、CpG组的细胞增殖率也均明显高于空白对照组(P<0.05);但E7Pb+CpG、E7Pc+CpG、CpG组间比较,差异则无统计学意义(P>0.05).LDH释放法榆测显示,效靶比为100:1时,E7Pa+CpG、E7Pb+CpG、E7Pc+CpG、CpG和空白对照组CTL 活性分别为(85.9±3.0)%、(55.9±2.5)%、(60.2±1.5)%、(41.0±1.7)%和(4.1±1.0)%,E7Pa+CpG组与空白对照组比较,差异有统计学意义(P<0.01);E7Pb+CpG、E7Pc+CpG、CpG组分别与空白对照组比较,差异也有统计学意义(P<0.05);但E7Pb+CpG、E7Pc+CpG、CpG组间比较,差异则无统计学意义(P>0.05).在肿瘤组织及外周血中,小鼠IFN-γ、IL-2的表达水平,E7Pa+CpG组与空白对照组比较,差异均有统计学意义(P<0.01);E7Pb+CpG、E7Pc+CpG和CpG组分别与空白对照组比较,差异也均有统计学意义(P<0.05);但E7Pb+CpG、E7Pc+CpG、CpG组问比较,差异则无统计学意义(P>0.05).小鼠体内的肿瘤体积,各实验组肿瘤生长均明显被抑制,接种后第60大,E7Pa+CpG组与空白对照组比较,差异有统计学意义(P<0.01);E7Pb+CpG、E7Pc+CpG和CpG组分别与空白对照组比较,差异也均有统计学意义(P<0.05);但 E7Pb+CpG、E7Pc+CpG、CpG组间比较,差异则无统计学意义(P>0.05).结论 在动物模型中,针对TAP筛选的HPV16 E7多肽联合CpG制备的HPV16多肽疫苗,可以有效治疗HPV16 E7阳性的肿瘤.     

四川省乐山市2008-2012年疑似预防接种异常反应（AEF1）监测情况分析报告

目的：是为了解我市2008-2012年疫苗接种后,疑似预防接种异常反应（AEFI）发生的情况,为下一步处理AEFI提供资料。方法：本文统计了乐山市2008—2012年疑似预防接种异常反应（aEH）207例进行分类统计。结果：在207例AEFI中,涉及22种疫苗,主要是DPT46例（22．22％）、MV49例（23．67％）、HepB20例（9．66％）。乐山市AEFI个案207例,覆盖全市11个区、县。在207例AEFI中,一般反应多,为例176例（85．02蚴;异常反应21例（10．15％）;其次为偶合症7例（3．38％）,心因性反应2例（0．97％）。从年份来说,2008年为最多主要和当年进行麻疹疫苗的强化免疫工作有关,当年强化免疫接种达近50万人次。结论：从AEFI的发生率来看,总的报告发生率为3．18／10万剂,最高的为甲型流感疫苗36．7／10万剂,其次为百日咳一白喉一破伤风联合疫苗（DPT）7．67／10万剂、麻疹减毒活疫苗（MV）4．9／10万剂等。开展AEFI监测有助于及时发现AEFI的发生原因,采取正确措施,减少AEFI对免疫规划的负面影响。建议加强各级疾控中心、医疗机构和接种单位相关人员的培训,定期开展AEFI的监测督导工作,对存在的问题进行分析反馈,同时要加强与新闻媒体的有效沟通和理解,以减少负面影响。     

体外受精-胚胎移植后双侧输卵管异位妊娠1例

<正>患者,女,31岁,G3P0,因"胚胎移植后第32天,阴道流血10+天"就诊于我院。患者9年前有异位妊娠史,曾接受甲氨蝶呤注射治疗,1年前有自发流产病史。患者1个月前于外院行体外受精胚胎移植,移植后第12天、第14天、第21天、第24天血β-HCG分别为162mIU/ml、357mIU/ml、2547mIU/ml及2897mIU/ml。胚胎移植后第26天,患者出现阴道流血,血β-HCG为2295mIU/ml。入院查体:患者下腹部压痛明显,不伴反跳痛或肌紧张,未扪及明显包块。盆腔检查见阴道少量积血,宫颈口关     

Gardasil™ HPV vaccination: surveillance of vaccine usage and adherence in a military population

Objectives

To investigate the usage patterns and adherence rates with the quadrivalent HPV (qHPV) vaccine at Naval Medical Center San Diego.

Methods

This retrospective, cross-sectional study was conducted by using AHLTA (Electronic Health Record of DoD) to identify all qHPV recipients between 2006 and 2009. Charts were reviewed to extract demographic variables and immunization schedules for association analysis. Subjects were assigned intention-to-treat (ITT) if they initiated the series and reached the 1-year anniversary after dose-1 or in-progress (IP) if the series was incomplete and within 1-year. ITT subjects were designated non-adherent or adherent based on 1–2 or 3 doses received.

Results

6792 females and 46 males with respective mean ages (years) of 19 (95% CI: 10–29) and 27 (95% CI: 9–46) initiated the qHPV series. The evaluable ITT population consisted of 5088 females and 31 males. The adherence rate for females was 32% (1656/5088) versus 3% (1/31) for males. For females, adherence declined from 45%, 24%, to 14% with respect to increasing age: 8–17, 18–26, 27–50 years. Adherence declined accordingly by beneficiary status: dependent daughters (43%), spouses (21%) and active duty (16%); and by clinic of vaccine initiation: Pediatrics/Adolescent (45%), Primary Care (38%), Immunization (21%), and OB/GYN (9%). Males were predominantly active duty 84%, vaccinated through immunization clinics 84%, and poorly adherent 3%.

Conclusions

Optimal HPV immunization efficacy is derived from vaccine adherence and HPV naivety. This study of qHPV adherence has provided insight into real-world suboptimal use post-marketing. Usage patterns and adherence rates were significantly associated with demographic characteristics.     

A Randomized Trial of Oral DHEA Treatment for Sexual Function,Well-Being,and Menopausal Symptoms in Postmenopausal Women with Low Libido

IntroductionDehydroepiandrosterone (DHEA) and its sulfate DHEAS, which are the most abundant steroids in women, decline with age. We have shown association between low sexual function and low circulating DHEAS levels in women.AimThe aim of this study was to evaluate whether restoration of circulating DHEA levels in postmenopausal women to the levels seen in young individuals improves sexual function.MethodsNinety-three postmenopausal women not using concurrent estrogen therapy were enrolled in a 52-week randomized, double-blind, placebo controlled trial and received either DHEA 50 mg or placebo (PL) daily.Main Outcome MeasuresEfficacy was assessed through 26 weeks. The main outcome measures were the change in total satisfying sexual events (SSE) and the change in the Sabbatsberg Sexual Self-Rating Scale (SSS) total score. Secondary measures were the Psychological General Well-Being Questionnaire (PGWB), and the Menopause—Specific Quality of Life Questionnaire (MENQOL). Hormonal levels, adverse events (AEs), serious adverse events (SAEs) and clinical labs were evaluated over 52 weeks.ResultsEighty-five participants (91%) were included in the 26-week efficacy analysis. There were no significant differences between the DHEA and PL groups in the change in total SSE per month or the SSS, PGWB, and MENQOL change scores. Overall AE reports and number of withdrawals as a result of AEs were similar in both groups; however more women in the DHEA group experienced androgenic effects of acne and increased hair growth.ConclusionsIn this study treatment of postmenopausal women with low sexual desire with 50 mg/day DHEA resulted in no significant improvements in sexual function over PL therapy over 26 weeks. Panjari M, Bell RJ, Jane F, Wolfe R, Adams J, Morrow C, and Davis SR. A randomized trial of oral DHEA treatment for sexual function, well-being and menopausal symptoms in postmenopausal women with low libido. J Sex Med 2009;6:2579–2590.     

A phase II, single-arm study of the anti-α5β1 integrin antibody volociximab as monotherapy in patients with platinum-resistant advanced epithelial ovarian or primary peritoneal cancer

Objective

This phase II, multicenter, single-arm, two-stage study in platinum-resistant, advanced epithelial ovarian or primary peritoneal cancer evaluated the efficacy, safety, and tolerability of weekly single-agent volociximab. Pharmacokinetic/pharmacodynamic (PK/PD) studies were also performed.

Methods

Sixteen patients were enrolled in Stage 1. Volociximab was administered at 15 mg/kg IV qwk until progression of disease or drug intolerability. Tumor response was assessed every 8 weeks. Serum samples for PK or whole blood for the evaluation of circulating tumor cells, endothelial cells, and endothelial progenitor cells were obtained on Days 1, 8, 15, 29, and 50. Ascites from one patient was collected for volociximab concentration analysis. Archived tumor tissue was analyzed by immunohistochemistry (IHC) for α5 integrin expression.

Results

Safety data are available on all 16 patients; 14 were evaluable for efficacy. One patient had stable disease at 8 weeks. The remaining 13 progressed on treatment. Twelve patients (75%) experienced study-related adverse events (AEs); the most common (≥ 20%) were headache and fatigue. Three patients experienced possible study-related serious AEs (SAEs): reversible posterior leukoencephalopathy syndrome, pulmonary embolism, and hyponatremia. Peak serum concentrations of volociximab increased 2-3 fold from Day 1 to Day 50. Clinically relevant trough levels were achieved (> 150 μg/mL). IHC analysis of archived tumor sections showed low-to-moderate expression of α5 integrin on all ovarian cancer tissue evaluated.

Conclusion

Despite insufficient clinical activity in this refractory patient population to continue the study, weekly volociximab was well tolerated, and the gained understanding of the mechanism of action of volociximab will inform future development efforts.     

Epidemiological study in Okinawa, Japan, of human papillomavirus infection of the uterine cervix

OBJECTIVE: To investigate the prevalence and type distribution of human papillomavirus (HPV) in women with normal cervical cytology and with cervical intraepithelial neoplasia I to III(CIN) or carcinoma of the cervix in Okinawa, Japan. METHODS: We investigated HPV DNA in 4,078 subjects with cytologically normal cervices, 279 subjects with CIN, and 383 subjects with cervical cancer in Okinawa Prefecture in Japan. The presence of HPV DNA was also compared among generations. HPV DNA was both detected and typed using polymerase chain reaction (PCR). RESULTS: The HPV positivity rate was 10.6% in the subjects who were normal on cervical cytodiagnosis. In each generation, the positivity rate was 20.4% in women aged 20-29 years and approximately 10% in the groups aged 30-89 years, with significant differences among generations. The HPV positivity rates in CIN and cervical cancer groups were 76.0% and 86.2%, respectively, with no significant difference between the groups. The positivity rate of HPV 16 decreased with age in both CIN and cervical cancer groups. CONCLUSION: Among non-cancer subjects, HPV infection rates were almost 20% in women aged 20-29 years and 10% in women aged 30-89 years. HPV16-positive CIN or carcinoma were more prevalent in the younger women, suggesting that HPV16-infected epithelial cells rapidly progress to cervical cancer.     

A National Survey of Canadian Adults on HPV: Knowledge,Attitudes, and Barriers to the HPV Vaccine

ObjectiveIdentifying human papillomavirus (HPV) vaccination motivators and barriers among adults could lead to new approaches to improve HPV vaccination rates in non-pediatric populations. This Canadian survey aimed to assess current knowledge of, attitudes towards, and barriers to the HPV vaccine among the general public.MethodsAn online panel was used to survey HPV unvaccinated women (n = 802) and vaccinated women (n = 250) 18 to 45 years old, as well as 18- to 26-year-old men (n = 200), in May and June 2016. A 16-item questionnaire collected data on sociodemographic factors, health-seeking behaviours, knowledge of HPV infection and its consequences, and the HPV vaccine. Data were stratified by sex and by vaccination status among women.ResultsThe majority of individuals somewhat or strongly agreed that vaccination is an important aspect of disease prevention (vaccinated women, 93%; unvaccinated women, 85%; and men, 59%). However, a high proportion of patients were concerned about vaccine safety (vaccinated women, 26%; unvaccinated women, 40%; and men, 36%). Moreover, 58% to 61% of participants were generally cautious about taking any vaccine. The number one reported barrier to vaccination was not having a recommendation from a doctor (38%). Cost was seen as a barrier by only 18% to 20% of participants.ConclusionCanadian participants show a broad diversity in HPV knowledge and regarding barriers to vaccination. The youngest populations (vaccinated women and men) showed higher levels of knowledge regarding HPV.     

Sexual behaviour of young people

20% of the world's population is aged 10-19 years. Annually, almost 15 million young women under age 20 become mothers. However, surveys in developing countries show that 20-60% of the pregnancies and births to women under age 20 are mistimed or unwanted. While later marriage age in many places has provoked a decline in birth rates among young women, levels of sexual relations before marriage are increasing. Such sexual behavior opens sexually active young women to the risks of unwanted pregnancies, unsafe abortion, and sexually transmitted diseases (STDs). Millions of young people become infected with STDs annually. Among all age groups in the US, young women aged 15-19 have the highest incidence of gonorrhea among females and young men aged 15-19 have the second highest incidence among males. At least half of all people infected with HIV are under age 25. The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction (HRP) completed 9 studies in 1996 on adolescent reproductive health. 14 studies were completed before 1996, and 18 are still underway.     

Young Deaf Adults' Knowledge of Human Papillomavirus and Human Papillomavirus Vaccine's Effectiveness in Preventing Cervical,Anal, Penile,and Oral Cancer

Study ObjectiveTo describe knowledge and risk perception of human papillomavirus (HPV) among deaf adults who use American sign language (ASL) comparison with hearing adults in the United States.DesignSecondary HPV knowledge data for the deaf subset sample were drawn from the Health Information National Trends survey in ASL that was administered between 2015 and 2018. HPV knowledge data for the hearing subset sample were drawn from cycle 5 of the Health Information National Trends survey in English that was administered in 2017.SettingSurveys are a nationally based survey of deaf ASL users in the United States and a nationally based survey of hearing non-ASL users in the United States.ParticipantsThe age of the deaf and hearing subset samples was determined on the basis of catchup vaccine eligibility criteria as outlined by the Centers for Disease Control and Prevention that recommends catchup vaccination in women, men who have sex with men, immunocompromised individuals, and those who identify as transgender.Interventions and Main Outcome MeasuresWe examined HPV, HPV vaccine, and HPV-related cancer knowledge in deaf and hearing subsets.ResultsOur sample consisted of 235 deaf and 115 hearing adults aged 18-26 years. Of the deaf participants 58% (136/235) reported knowledge of HPV compared with 84% (97/115) of hearing participants (P < .001). Hearing participants showed higher accuracy in risk perception of HPV relation to cervical cancer compared with deaf participants (P < .001). Hearing participants were more likely to have heard of the HPV vaccine as well as believe it is successful in preventing cervical cancer compared with deaf participants (P < .001).ConclusionDeaf ASL users are less likely to have knowledge of HPV, virus-related cancer risk, and preventative vaccination compared with hearing peers.     

Cycle control,tolerability, and satisfaction among women switching from 30-35 microg ethinyl estradiol-containing oral contraceptives to the triphasic norgestimate/25 microg ethinyl estradiol-containing oral contraceptive Ortho Tri-Cyclen LO

OBJECTIVE: To determine cycle control, tolerability, and satisfaction among women (aged 18-45) switching from oral contraceptives (OCs) containing 30-35 microg ethinyl estradiol (EE) to Ortho Tri-Cyclen LO (norgestimate 180/215/250 microg/EE 25 microg) and Loestrin Fe 1/20 (norethindrone acetate 1 mg/EE 20 microg). DESIGN: A subset of patients from a study comparing Ortho Tri-Cyclen LO (N = 864) with Loestrin Fe 1/20 (N = 565) was analyzed. The subset was defined as those who had taken a 30-35 microg EE-containing OC within 60 days of study start. The total number of cycles of exposure for the subset was 6,054 for Ortho Tri-Cyclen LO and 3,814 for Loestrin Fe 1/20. Additional analyses evaluated switchovers from Ortho Tri-Cyclen to Ortho Tri-Cyclen LO (N = 111). MAIN OUTCOME MEASURES: Cycle control was assessed by daily diary cards reporting the frequency, severity, and duration of bleeding/spotting. Discontinuation rates due to adverse events (AEs) were considered to reflect tolerability. Satisfaction was evaluated by questionnaire. RESULTS: The proportion of cycles in which subjects experienced breakthrough bleeding and/or spotting was significantly lower with Ortho Tri-Cyclen LO than Loestrin Fe 1/20. Discontinuations due to AEs and serious AEs were comparable for Ortho Tri-Cyclen LO (3.4% and 0.6%, respectively) and Loestrin Fe 1/20 (3.2% and 0.7%, respectively). More women on Ortho Tri-Cyclen LO versus Loestrin Fe 1/20 were very or somewhat satisfied at Cycle 6 (86% vs. 81.1%; P < 0.05) and last visit (81.6% vs. 78.1%; P < 0.05). At Cycle 6, 89.3% of Ortho Tri-Cyclen to Ortho Tri-Cyclen LO switchovers were very or somewhat satisfied, and 72.6% desired to continue taking Ortho Tri-Cyclen LO after study conclusion. Conclusions-Switchovers from OCs containing 30-35 microg EE to Ortho Tri-Cyclen LO had excellent cycle control and tolerability, and were satisfied.     

Racial and Ethnic Differences in HPV Knowledge,Attitudes, and Vaccination Rates among Low-income African-American,Haitian, Latina,and Caucasian Young Adult Women

ObjectiveTo examine facilitators and barriers to HPV vaccine uptake in African-American, Haitian, Latina, and White women aged 18-22 and to determine vaccination completion rates among participants over 5 years.DesignUsing semi-structured interviews and medical record review, we assessed HPV knowledge and attitudes towards HPV vaccination among young women. We then determined their subsequent HPV vaccination initiation and completion rates. We used constructs from the Health Belief Model and methods based in grounded theory and content analysis to identify attitudes towards HPV vaccination cues to initiate vaccination, perception of HPV, and how communication about issues of sexuality may impact vaccine uptake.ParticipantsWe enrolled 132 African-American, Haitian, Latina, and White women aged 18-22 years who visited an urban academic medical center and 2 affiliated community health centers between the years 2007 and 2012.Main Outcome MeasuresIntent to vaccinate and actual vaccination rates.ResultsOf 132 participants, 116 (90%) stated that they were somewhat or very likely to accept HPV vaccination if offered by their physician, but only 51% initiated the vaccination over the next 5 years. Seventy-eight percent of those who initiated vaccination completed the 3 doses of the HPV vaccine series. Forty-five percent (45%, n = 50) of the adolescents who started the series completed 3 doses over a 5-year period: 42% of African-American (n = 16), 33% of Haitian (n = 13), 63% of Latina (n = 10), and 65% of White young women (n = 11) completed the 3-dose series. Despite low knowledge, they reported high levels of trust in physicians and were willing to vaccinate if recommended by their physicians.ConclusionDesire for HPV vaccination is high among older adolescents, physician recommendation, and use of every clinic visit opportunity may improve vaccine uptake in young women. More White young women completed the HPV vaccine series compared with other race and ethnic young women.