预防性人乳头瘤病毒疫苗的应用进展

宫颈癌是导致全球妇女病死率排名第2位的肿瘤,高危型人乳头瘤病毒（HPV）持续感染与妇女宫颈癌密切相关,预防性HPV疫苗是预防宫颈癌的有效方法,并逐步开展应用.此文对HPV疫苗的作用机制和临床应用的安全性及有效性等进行综述.     

Perceptions and acceptability of HPV vaccination among parents of young adolescents: A multicenter national survey in China

Prophylactic HPV vaccines target young adolescents to prevent related cervical lesions and even genital warts prior to onset of sexual activity. Parental consent is often essential for success of vaccination program for this age group. We conducted a national multicenter study to explore the acceptability of HPV vaccination among parents of young adolescents and associated factors in relevant parent decision making in China. A total of 2899 parents of young adolescents (11–17 years) participated in the survey between November 28, 2011 and May 9, 2012, but four were excluded from analysis because of inconsistencies in their given information in the questionnaire. Mothers accounted for 62.8% of the parent participants. The mean age of the parents was 40.40 (standard deviation, 4.68) years. Only 36.2% of the parents accepted the vaccine for their children. Knowledge about HPV and HPV vaccine was a positive correlate with HPV vaccination acceptability (P_trend = 0.003). Grade of child (P_trend = 0.015), prior vaccination experience outside the National Expanded Program on Immunization (OR: 1.43; 95%CI: 1.19–1.72), fear of cervical cancer and/or genital warts (OR: 2.47; 95%CI: 2.00–3.05), and prior consultation regarding HPV vaccine information (OR: 2.35; 95%CI: 1.57–3.52) were also positively associated with higher HPV vaccine acceptability. The acceptability was lower in mothers (OR: 0.45; 95%CI: 0.37–0.54) and who had better education (P_trend = 0.009). 57.3% of the parents agreed that the most appropriate venue for HPV vaccination was the local center for disease prevention and control. In conclusion, our study indicates a low acceptability of HPV vaccination among parents of young adolescents in China. We understand there are many challenges in implementing HPV vaccination program. Our findings will serve as valuable references for future HPV vaccination policies and campaigns after HPV vaccines are approved in China.     

Cervical cancer and HPV: Awareness and vaccine acceptability among parents in Morocco

Cervical cancer is a major public health concern in Morocco where it represents the second most common and lethal cancer in women. Human papillomavirus (HPV) vaccines have been licensed in Morocco since 2008 but there are no available data on their acceptability. This study aimed to assess awareness of HPV and the vaccine, and to identify factors associated with acceptability of the vaccine among parents in Morocco.     

Human papillomavirus vaccine knowledge and hypothetical acceptance among women in Appalachia Ohio

Objective

To assess hypothetical acceptance of the human papillomavirus (HPV) vaccine for themselves and a daughter age 9–12 years among Appalachia Ohio women.

Methods

Women with an abnormal Pap smear and randomly selected women with a normal Pap smear from 17 clinics completed an interview in 2006–2008.

Results

From 1131 original study participants, 807 (71%) completed a survey about the HPV vaccine for their daughters and themselves. Nearly half, 380 (47%), of the participants had heard of a vaccine to prevent cancer, and 362 (95%) of respondents had heard of HPV. The participants were then told that the FDA had approved a vaccine to prevent HPV. Only 379 (38%) participants identified girls ages 9–12 years as a group who should get the vaccine. After being given the official HPV vaccine recommendation statement, 252 (31%) wanted the vaccine; 198 (25%) were “not sure”; and 353 (44%) did not want the vaccine for themselves. With respect to giving the HPV vaccine to a daughter ages 9–12 years, participants responded “yes” 445 (55%); “not sure” 163 (20%); or “no” 185 (23%). Numerous reasons were provided supporting and opposing vaccine acceptance for themselves and for a daughter. Their physician's recommendation for the HPV vaccine increased vaccine acceptance to 86% for themselves and 90% for a daughter.

Conclusion

Knowledge, acceptance, and barriers about the HPV vaccine vary among women living in Appalachia Ohio. Physician recommendation is a key facilitator for vaccine diffusion in this region.     

Acceptability of human papillomavirus vaccination among medical students in Mangalore,India

Background

The highly prevalent cervical cancer can be prevented through a vaccine. However, the uptake of the Human Papillomavirus vaccine in the general population continues to be low. Medical students, as healthcare providers in the future, would be influential in affecting the community's views and thereby the uptake of the Human Papillomavirus vaccine. Hence, there is a need to promote the right attitude for prompt implementation of this vaccine among medical students. None of the studies in India have so far documented the proportion of vaccinated population among medical students or an intervention strategy to eliminate the barriers to Human Papillomavirus vaccine.

人类乳头瘤病毒疫苗保护效果Meta分析

目的 评价人类乳头瘤病毒(HPV)疫苗流行病学保护效果.方法 电子检索National Center for Biotechnology Information(NCBI)(《美国国家医学图书馆数据库》)、《Cochrane协作网图书馆》等数据库,将有关接种HPV流行病学保护效果的研究文献进行分析.文献资料使用RevMan5.1软件进行meta分析.结果 符合标准的文献共10篇,均为随机对照试验(RCT).HPV疫苗对相关基因型人类乳头瘤病毒(HPV)引起的尖锐湿疣的疫苗保护效果(VE)为94％(95％ CI:91％～96％),对外阴上皮内瘤样病变Ⅱ/Ⅲ级(VIN2/3)和阴道上皮内瘤样病变(VaIN)的VE为96％(95％CI:86％～99％),对宫颈上皮内瘤样病变Ⅱ/Ⅲ级(CIN2/3),原位癌(AIS)的VE分别为98％(95％ CI:96％-99％)和79％(95％Cl:55％-90％).结论 接种HPV疫苗可以降低尖锐湿疣、VIN2/3、VaIN、CIN2/3和AIS的发病率,具有良好的保护效果.     

我国女性人乳头瘤病毒(HPV)感染的流行病学现状

宫颈癌给我国乃至全世界都造成了沉重的社会经济负担,人乳头瘤病毒（human papilloma virus,HPV）尤其是高危型HPV与宫颈癌前病变和宫颈癌密切相关,HPV疫苗的出现无疑给广大女性带来了福音。目前多个国家已经开展了HPV的疫苗免疫计划,我国大陆虽然刚刚批准了二价的HPV疫苗在国内使用,但仍缺乏系统的HPV感染的流行数据,因而本文就我国女性HPV感染的流行病学状况作一综述,旨在为HPV疫苗的研发和应用及宫颈癌防治工作提供指导。     

预防性四联人乳头瘤病毒疫苗的研究及应用进展

肛门生殖器部位人乳头瘤病毒(HPV)感染是常见的性传播疾病之一,高危型HPV感染不仅与女性宫颈癌关系密切,在其他肛门生殖器恶性肿瘤的发生发展中亦起着重要作用.预防性四联HPV疫苗(抗HPV 6、11、16、18)的出现为预防和控制HPV感染提供广阔的前景,更使得疫苗预防HPV相关肿瘤成为可能.此文就四联HPV疫苗的研究及其应用进展进行综述.     

上海市中学生家长饮酒相关知识态度行为

了解上海市中学生家长饮酒相关知识、态度、行为现状,为从家庭方面开展青少年饮酒干预活动提供依据.方法 采用自填问卷调查方法,对上海市46所中学(初中25所、普通高中11所、职业高中10所)4 550名学生家长进行调查.结果 中学生家长饮酒相关健康知识平均总得分为(4.8±2.0)分,属于“一般”水平;但对于长期大量饮酒可导致的疾病知晓率较低,完全回答正确的比例仅占11.9%.对于孩子在各场合饮酒的态度,11.5%~19.0%的家长表示赞同,13.9% ~16.2%的家长持无所谓态度.中学生家长过去1 a曾饮酒率较高(47.3%).32.2%的家长未对孩子进行过针对饮酒危害知识教育.对饮酒相关知识、态度及行为方面的表现,母亲好于父亲,父亲好于其他监护人;初中生家长好于高中生家长,高中生家长好于职业高中家长.结论 中学生家长对饮酒的健康危害认识不足,对于孩子饮酒行为的容忍度较高.建议开展针对中学生家长的饮酒危害健康教育,并把孩子的父亲及职业高中学生家长列为饮酒危害教育的重点人群.     

Acceptability of human papillomavirus vaccination among male university students in the United Arab Emirates

Objective

To assess the knowledge about and acceptability of human papillomavirus (HPV) vaccination among male university students in the United Arab Emirates (UAE).

Methods

Between June and August 2012 we approached 356 male university students from the UAE and asked them to fill out a 12-item self-administered questionnaire.

Results

Knowledge of HPV was low among the university students who participated (32%). Less than half of the students (46%) indicated they would accept HPV vaccination, and around 30% were unsure of their decision. Safety (68%), protection of their female partner (65%) and doctor's recommendation (64%) were rated as the factors most likely to increase the uptake of HPV vaccination among participating students. The factors rated most likely to stop students from using the vaccine were fear of side effects (85%), absence of clear benefits (38%) and objections from a religious authority (25%). Marital status and sexual activity were associated with greater knowledge of HPV but not with greater acceptance of vaccination among university students in the UAE.

Conclusion

Overall acceptability of and knowledge about HPV infection and vaccination were low in a sample of male university students in the UAE. Marital status and sexual activity are associated with greater knowledge of HPV infection but have no effect on the acceptability of HPV vaccination.     

Long-term effectiveness of human papillomavirus vaccines among adult women: A real-world scenario

ObjectiveThis study aimed to determine the real-world effectiveness of bi- or quadrivalent human papillomavirus (HPV) vaccines in Thai adult women ≥5 years post-vaccination in reducing HPV 16/18-associated low-grade squamous intraepithelial lesions or worse (LSIL+), atypical squamous cells of undetermined significance or worse (ASC-US+), and HPV 16/18 positivity.MethodsA retrospective cohort study was conducted among Thai women aged 20–45 years in Bangkok. The vaccinated and unvaccinated groups were matched according to baseline years. HPV/Pap test results were collected from the medical records and/or obtained by cervical sample collection at the study sites. Adjusted hazard ratios were measured using multivariable Cox regression analyses.ResultsA total of 993 participants (493 vaccinated and 500 unvaccinated) were enrolled from 2018 to 2019. The median ages at baseline of the vaccinated and unvaccinated groups were 33 years (interquartile range [IQR] 27–38) and 34 years (IQR 30–38), respectively. The median follow-up periods were 7.3 years (IQR 6.1–8.6) and 7.2 years (IQR 5.8–8.9) for the vaccinated group and the unvaccinated group, respectively. More women in the vaccinated group were single (29.2% vs. 13.2%, P < 0.001) and university graduates (83.2% vs. 75.4%, P = 0.009). The vaccinated and unvaccinated groups had similar personal monthly incomes (>20,000 THB/month, 63.9% vs. 62.4%, respectively, P = 0.685). There were no cases of HPV 16/18-associated LSIL+ in the vaccinated group, whereas there were four cases in the unvaccinated group. HPV vaccine effectiveness was 88.0% (95% CI 2.0–98.5) in the reduction of HPV 16/18-associated ASC-US+, and 84.6% (95% CI 43.5–95.8) in the reduction of HPV 16/18 positivity.ConclusionsHPV vaccine effectiveness was high in adult women in a real-world scenario in a developing country. Free HPV vaccination in adult women in this age group should be further explored when vaccine supplies are not limited.(HPV: human papillomavirus.LSIL+: low-grade squamous intraepithelial lesion or worse.ASC-US+: atypical squamous cells of undetermined significance or worse)     

徐州市小学生家长口腔保健知识调查分析

目的了解徐州市小学生家长关于口腔卫生保健的知晓情况,为徐州市儿童口腔预防保健工作提供预见性资料。方法采用随机抽样的方法,于2011年10月一12月对徐州市区的1074名小学生家长进行问卷调查。结果在所调查的问题中,对口腔健康对自己生活的重要性、保护孩子“六龄牙”的重要性、乳牙坏了是否需要治疗等问题上认知性很高,而对于窝沟封闭防龋、氟化物对牙齿的作用认知水平比较低,不同性别及学历水平的家长,在相关问题的知晓率上差异有统计学意义（P〈0．01）。结论徐州市小学生家长的口腔保健认知水平存在差异,部分学生家长1：7腔知识缺乏,口腔保健意识不足,应该有针对性的进行宣传和教育。     

Parental preferences for HPV vaccination in junior middle school girls in China: A discrete choice experiment

BackgroundCervical cancer is the second most common cancer in Chinese women. Human papillomavirus (HPV) vaccines have not yet been introduced in the Chinese national immunization program, and people vaccinate voluntarily at their own expense. Therefore, it is important to study the factors that could impact parents' decisions for HPV vaccination.ObjectiveTo quantify parental preferences regarding HPV vaccination for junior middle school-aged girls.MethodA discrete choice experiment (DCE) survey was conducted to assess parents' preferences for HPV vaccines. Data were collected from parents of girls aged 12–16 years in 11 middle schools of Shandong Province. We evaluated preferences for five attributes of HPV vaccination (vaccine effectiveness, protection duration, risk of side effects, cost, and vaccination location). Conditional logit regressions were adopted for analyses.Results995 parents completed valid DCE questions. All attributes influenced parents’ willingness to vaccinate. Comparatively highly educated parents preferred more on higher vaccine effectiveness and lower side effects risks while more intended to accept higher prices. Parents were willing to trade 2326.32 CNY for an increase in HPV vaccine effectiveness from 50% to 90%. Nearly 70% percent of the respondents were predicted to prefer multiple improvements in HPV vaccination (protection increased from 70% to 95%, duration increased from 9 years to 15 years, and vaccination location changed from vaccination center to school) to the base case.ConclusionVarious vaccine characteristics and implementation strategies influence respondents’ preferences. Health education with evidence-based information about HPV vaccines would help parents make informed decisions. The findings can also assist agencies responsible for HPV vaccination implementation and cervical cancer prevention in China in decisions regarding vaccination financing and vaccine approval.     

人乳头瘤病毒治疗性活载体疫苗的研究进展

高危型人乳头瘤病毒(HPV)-16和HPV-18在宫颈癌的致病过程中起着重要作用.近年来,HPV预防性疫苗已成功上市,但其费用较高,且不能治疗已感染的患者及相关的损伤.多种靶向E6/E7抗原的HPV治疗性疫苗已进入临床前模型和临床试验,包括活载体疫苗,多肽、蛋白疫苗,核酸疫苗及细胞疫苗.此文就HPV治疗性活载体疫苗进行...     

Knowledge and acceptability of the HPV vaccine by school children and their parents in Birmingham

Previous research indicates that knowledge about the HPV vaccine amongst the general public is inadequate 1, 2 and 3. However, since the introduction of the NHS vaccination programme for girls aged 12–13 from autumn 2008 awareness may have increased. We aimed to assess their knowledge about the vaccine, their likelihood of vaccine uptake and whether these were affected by demographic variables such as gender and ethnicity. Questionnaires which were designed to test levels of knowledge about the vaccination programme were distributed to a sample of 12–13 year-old boys and girls and their parents from three schools in Birmingham. In total, 568 questionnaires were distributed, with 434 responses (76.4%).     

我国西部地区城市和农村中学生对人乳头瘤病毒及其预防性疫苗的认知及态度调查

目的 调查我国西部地区城市和农村中学生对人乳头瘤病毒(human papillomavirus, HPV)及其预防性疫苗的认知及态度,为今后在西部地区适龄接种人群中推广HPV疫苗提供参考依据。方法 采取以人群为基础的横断面调查。采用便利抽样,分别于 2015年、2016 年在四川成都市和新疆乌鲁木齐市各抽取一所城市中学和一所农村中学,对所选学校的初一学生进行问卷调查。结果 本研究共纳入2062名学生,有61.3%的学生接触过性教育或性知识,仅7.8%的学生对青春期知识非常了解。有34.6%的学生听说过宫颈癌,城市学生的知晓率高于农村学生(37.7% vs 31.7%,P＜0.05)。分别有13.7%和17.7%的学生听说过HPV和HPV疫苗。有50.0%的城市学生和59.6%的农村学生表示愿意接种HPV疫苗,接种意愿存在城乡差异(P＜0.05)。来自乌鲁木齐市农村地区且相关认知合格的女学生更愿意接种 HPV 疫苗。结论 我国西部地区城乡中学生对青春期健康、宫颈癌、HPV 及 HPV 疫苗的认知水平较低且存在差异。应将HPV相关知识纳入以学校为基础的健康教育,并根据城乡学生的差异进行有针对性的教育,从而提高城乡适龄接种人群对HPV及其疫苗的正确认知,为将来提高HPV疫苗在青少年人群中的接种率提供基础。     

Acceptability of the human papillomavirus vaccine and reasons for non-vaccination among parents of adolescent sons

Routine administration of the quadrivalent human papillomavirus (HPV) vaccine has been recommended for 11–12-year-old males since 2011, but coverage remains low. In a U.S. national sample of parents of 11–17-year-old males (n = 779), 78.6% of parents reported their sons had not received the HPV vaccine. The most common reason for non-vaccination (56.7%) was “My doctor or healthcare provider has not recommended it.” Parents citing only logistical reasons for non-vaccination (e.g., lack of recommendation, access, or education, n = 384) reported significantly higher vaccine acceptability than parents reporting a combination of attitudinal (e.g., concerns about vaccine safety or efficacy) and logistical barriers (n = 92), while parents citing only attitudinal barriers (n = 73) reported the lowest level of vaccine acceptability. In sum, many parents are willing but have not vaccinated sons due to logistical barriers, most commonly lack of healthcare provider recommendation. These findings have important implications for increasing HPV vaccination coverage among adolescent males.     

湖北省两市初一学生毒品滥用认知和行为调查

目的 了解湖北省两市初一学生药物滥用认知、态度和行为情况.方法 采用分层整群随机抽样方法抽取湖北省襄樊、大冶两市的城区和乡镇4所中学的初一学生进行自填式问卷调查,资料采用SPSS 12.0软件处理.结果 1079名初一学生中常见毒品知晓掌握好的有80.00%左右,34.24%的学生对毒品成瘾性的了解差;54.47%和41.79%的学生对毒品对大脑和身体危害性了解差,30.00%左右的学生对抵御毒品和吸毒行为的认知差;3.20%的学生对毒品好奇.1.58%的男生和1.22%的女生偶尔使用过毒品;首次使用毒品的平均年龄为9.5岁.25.20%左右的学生"曾劝阻朋友远离毒品",在面对朋友或同伴劝诱尝试毒品时,只有44.05%～61.29%的学生表示会以不同的理由拒绝.结论 初一学生在毒品及其危害、认知方面存在不同程度的误解.     

Completion of the human papillomavirus (HPV) vaccine series among males with private insurance between 2006 and 2009

Little is known about initiation and completion among males who received the HPV vaccine on an off-label basis before 2009. This study utilized administrative claims data from a private insurance company to examine completion of the 3 dose HPV series among 514 males who initiated the vaccine between 2006 and May of 2009. Frequencies of HPV vaccination were examined and multivariate logistic regression estimated the odds of completing the entire series within 365 days of initiation. We found that only 21% of male initiators completed all 3 vaccine doses within 12 months and completion decreased over time. Series completion did not vary significantly by provider type. These findings suggest that difficulties may be encountered in fully vaccinating enough males to achieve adequate herd immunity in the future.