Human papillomavirus (HPV) vaccination and subsequent sexual behaviour: Evidence from a large survey of Nordic women

Objective

To assess whether recipients and non-recipients of the human papillomavirus (HPV) vaccine subsequently differ in terms of sexual risk taking behaviour.

Design

Cross-sectional survey. Sequential analyses constructed from self-reported age at vaccination, age at first intercourse and age at response.

Setting

A random selection of women aged 18–46 years living in Denmark, Norway and Sweden in 2011–2012, eligible for opportunistic or organized catch-up HPV vaccination.

Participants

A total of 3805 women reported to have received the HPV vaccine and 40,247 reported not to have received it. Among vaccinees, 1539 received the HPV vaccine before or at the same age as sexual debut, of which 476 and 1063 were eligible for organized catch-up and opportunistic vaccination, respectively.

Main outcome measures

Self-reported sexual behaviour, compared by hazard ratios and odds ratios for women who received the HPV vaccine before or at the same age as sexual debut versus women who did not receive the HPV vaccine.

Results

HPV vaccination did not result in younger age at first intercourse. Women who received the HPV vaccine before or at the same age as sexual debut did not have more sexual partners than did non-vaccinees. Non-use of contraception during first intercourse was more common among non-vaccinees than among HPV vaccinees. The results were similar for organized catch-up and opportunistic vaccinees.

Conclusion

Women who received the HPV vaccine before or at the same age as sexual debut did not subsequently engage more in sexual risk taking behaviour than women who did not receive the HPV vaccine.     

Men who have sex with men who do not access sexual health clinics nor disclose sexual orientation are unlikely to receive the HPV vaccine in the UK

BackgroundMen who have sex with men (MSM) are recommended the Human Papillomavirus (HPV) vaccination due to their higher risk of genital warts and anal cancer.PurposeTo examine HPV vaccine acceptability amongst MSM in the UK.MethodsUsing advertisements via Facebook, MSM were recruited to an online survey measuring motivations for HPV vaccination. Logistic regression was performed to identify predictors of HPV vaccine acceptability.ResultsOut of 1508 MSM (median age = 22, range: 14–63 years) only 19% knew about HPV. Overall, 55% of MSM were willing to ask for the HPV vaccine and 89% would accept it if offered by a healthcare professional (HCP). Access to sexual health clinics (SHCs) [OR = 1.82, 95% CI 1.29–2.89], the disclosure of sexual orientation to a HCP [OR = 2.02, CI 1.39–3.14] and HIV-positive status [OR = 1.96, CI 1.09–3.53] positively predicted HPV vaccine acceptability. After receiving information about HPV, perceptions of HPV risk [OR = 1.31, CI 1.05–1.63], HPV infection severity [OR = 1.89, CI 1.16–3.01), HPV vaccination benefits [OR = 1.61, CI 1.14–3.01], HPV vaccine effectiveness [OR = 1.54, CI 1.14–2.08], and the lack of perceived barriers to HPV vaccination [OR = 4.46, CI 2.95–6.73] were also associated with acceptability.ConclusionsAlthough nearly half of MSM would not actively pursue HPV vaccination, the vast majority would accept the vaccine if recommended by HCPs. In order to achieve optimal uptake, vaccine promotion campaigns should focus on MSM who do not access SHCs and those unwilling to disclose their sexual orientation.     

Factors associated with human papillomavirus vaccination among young adult women in the United States

Background

Human papillomavirus (HPV) vaccination is recommended to protect against HPV-related diseases.

Objective

To estimate HPV vaccine coverage and assess factors associated with vaccine awareness, initiation and receipt of 3 doses among women age 18–30 years.

Methods

Data from the 2010 National Health Interview Survey were analyzed to assess associations of HPV vaccination among women age 18–26 (n = 1866) and 27–30 years (n = 1028) with previous HPV exposure, cervical cancer screening and selected demographic, health care and behavioral characteristics using bivariate analysis and multivariable logistic regression.

Results

Overall, 23.2% of women age 18–26 and 6.7% of women age 27–30 years reported receiving at least 1 dose of HPV vaccine. In multivariable analyses among women age 18–26 years, not being married, having a regular physician, seeing a physician or obstetrician/gynecologist in the past year, influenza vaccination in the past year, and receipt of other recommended vaccines were associated with HPV vaccination. One-third of unvaccinated women age 18–26 years (n = 490) were interested in receiving HPV vaccine. Among women who were not interested in receiving HPV vaccine (n = 920), the main reasons reported included: not needing the vaccine (41.3%); concerns about safety of the vaccine (12.5%); not knowing enough about the vaccine (11.9%); not being sexually active (8.2%); a doctor not recommending the vaccine (7.6%); and already having HPV (2.7%). Among women with health insurance, 10 or more physician contacts within the past year and no contraindications, 74.5% reported not receiving HPV vaccine.

Conclusions

HPV vaccination coverage among women age 18–26 years remains low. Opportunities to vaccinate are missed. Healthcare providers can play an important role in educating young women about HPV and encouraging vaccination. Successful public health and educational interventions will need to address physician attitudes and practice patterns and other factors that influence vaccination behaviors.     

Willingness to participate in HIV vaccine trials among men who have sex with men in Chennai and Mumbai,India

Introduction

Men who have sex with men (MSM) are at disproportionately high risk for HIV in India and would benefit greatly from a safe and effective HIV vaccine. We assessed willingness to participate (WTP) in HIV vaccine trials and the impact of various trial characteristics on WTP among MSM in Mumbai and Chennai.

Methods

We used venue-based time-space sampling to recruit MSM at cruising sites and drop-in centers at community-based organizations. Structured survey interviews assessed sociodemographics, WTP and the impact of 10 trial characteristics on WTP. We tested for differences in WTP by sociodemographics and trial characteristics, and sociodemographic differences in the impact of trial characteristics on WTP.

Results

Among 400 participants (median age = 25 years), 46.9% identified as kothi, 40.0% panthi/double-decker, 13.0% gay/bisexual; 29.0% had primary school education or less; and 40.0% had monthly income < = 5000 INR (∼3USD/day). Overall, 48.1% reported being definitely willing to participate. Posttrial availability of an efficacious vaccine was the highest rated (90.98 on 100–point scale) trial characteristic, followed by availability of free medical treatment (90.79), life insurance (89.84) and side effects (79.81). Distance to the trial site, side effects, financial incentive, life insurance and free medical care had significant impacts on WTP, with differential importance of trial characteristics by sexual identity, education, income and living arrangement.

Conclusion

The prioritization of trial-related financial and healthcare provisions, including access to an efficacious vaccine posttrial, among MSM in India indicates the importance of trials providing such services, as well as the value of formative research in identifying key concerns among participating communities in resource-limited settings. The significant impact of trial characteristics on WTP suggests that providing trial benefits deemed fair and important, addressing logistical concerns, and supporting educational interventions to mitigate vaccine fears may support recruitment of MSM in India in fairly and ethically conducted HIV vaccine trials.     

Opinions et pratiques des médecins généralistes face à la vaccination anti-Papillomavirus

Aims

The purpose of this study was to assess the standpoint of family physicians in the Southern French region Provence-Alpes-Cote d’Azur concerning human Papillomavirus vaccination and to evaluate the factors associated with a favorable standpoint.

Methodology

A questionnaire was sent to a random sample of 1,000 family physicians. The survey focused on their profile, their views on vaccination generally and on HPV vaccination, their knowledge of HPV, their standpoint concerning STD prevention and cervical cancer screening. Multivariable linear regression system was used to study the variations associated with a favorable response to HPV vaccination.

Outcome

Response was 36.6%. The responses were analyzed taking into account gender of the family physicians, location and size of their practice. There was reasonable similarity amongst those questioned. Around 89.6% of family physicians answers were in favor of HPV. The ideal age for vaccination was between 11 and 13 years of age for 34.4% and between 14 and 15 for 53.9%. The family physicians most in favor of vaccination were those involved in screening for STDs, those who did not think that the vaccine would have a negative effect on the image of sexuality and on screening for cervical cancer, and those who were confident about the vaccine safety.

Conclusion

The study identified the negative elements concerning HPV in order to optimize information strategies among family physicians.     

Acceptability and uptake of female adolescent HPV vaccination in Hong Kong: A survey of mothers and adolescents

Background

Organized population-based HPV vaccination programs can be effective in reducing the burden of cervical cancer, especially in the absence of a comprehensive cervical screening program (e.g. Hong Kong). Assessment of vaccine acceptability is important when evaluating the feasibility and cost-effectiveness of such vaccination programs.

Methods

To provide a more representative and updated assessment on the acceptability of female adolescent HPV vaccination in Hong Kong, we conducted surveys in 2008 among 1022 mothers with daughters aged ≤18 years through random digit-dialing telephone interviewing and 2167 schoolgirls aged 11–18 years using two-stage stratified cluster sampling. We conducted the maternal survey again in 2012 with an independent group of 1005 mothers.

Results

In 2008, 2.4% (95% confidence interval [CI] = 1.8–3.2%) of the recruited schoolgirls reported having received HPV vaccination. In 2012, the mothers reported that 9.1% (7.0–11.6%) of their daughters who were in the same age range (11–18 years) as the schoolgirls had been vaccinated (p < 0.01). Regarding acceptability, 27.5% (24.8–30.4%) and 37.6% (34.5–40.8%) of the mothers were willing to have their daughters vaccinated at market price in 2008 and 2012 (p < 0.01), respectively. 27.1% (25.2–29.1%) of the schoolgirls were willing to receive HPV vaccination at market price in 2008. The willingness to pay for full-course vaccination among mothers had a median of US$128/HK$1000 (50% central range = US$64–192/HK$500–1500), i.e. substantially lower than the current market price.

Conclusions

The gap between acceptability and actual uptake of HPV vaccination among adolescent girls suggested that coverage is likely to be low without an organized HPV vaccination program, although the difference might be partially attributed to the possibility that at the time of the interview female adolescents who were willing to be vaccinated had not yet taken action. Policymakers should devise tailored, targeted and efficient vaccination strategies to achieve universal coverage for an effectively organized HPV vaccination program.     

The Health Technology Assessment of bivalent HPV vaccine Cervarix in Italy

Introduction

Health Technology Assessment (HTA) approach was applied to Human Papilloma Virus (HPV) vaccine in the Italian context.

Methods

Epidemiology and costs of HPV infection and related diseases, vaccine efficacy, clinical and economic impact of the HPV vaccination and women's knowledge and attitudes towards vaccination were assessed.

Results

HPV infections pooled prevalence in Italy was 19% (95%CI: 10–30%) and cervical cancer incidence was 9.8/100,000 per year. The mean costs for in situ and invasive carcinoma hospitalisation were estimated respectively in €1745.87 and €2616.16. HPV vaccines have demonstrated high efficacy and good safety profile. The meta-analysis on efficacy results in preventing persistent cervical infections by HPV16 and 18 for both HPV vaccines resulted in 87% (95%CI: 80–91%) and 78% (95%CI: 62–87%). Modelling the impact of vaccination with bivalent vaccine, it would reduce cancer cases by 67% and be cost-effective, with a cost per Quality Adjusted Life Years (QALYs) gained of €22,055.

Conclusion

The thoroughness of the evaluation allowed us accounting for all the aspects of HPV infection/diseases. The HTA report on the HPV vaccine demonstrated to be a comprehensive tool for an informed decision making process.     

Prevalence and associated factors of intention to participate in HIV voluntary counseling and testing for the first time among men who have sex with men in Hong Kong,China

Objective

We investigated the prevalence and associated factors of men who have sex with men (MSM) and had never participated in Human Immunodeficiency Virus (HIV) voluntary counseling and testing (VCT) but intended to do so in the next six months.

Method

An anonymous cross-sectional survey interviewed 577 MSM in Hong Kong, China, face-to-face or through an electronic questionnaire.

Results

We identified 245 MSM who had never participated in VCT (never-testers), among whom 12.7% intended to do so in the next six months. Factors associated positively with high behavioral intention were: 1) perceived necessity to participate in HIV test regularly (multivariate odds ratios (ORm) = 4.54, 95% confidence interval (CI): 1.30–15.83), 2) perception that > 20% of the local MSM had participated in VCT (ORm = 17.86, 95% CI: 1.89–169.08) and 3) perceived higher chance to have sex with people living with HIV (PLWH) in the next six months (ORm = 2.92, 95% CI: 1.08–7.93). Negatively associated factors were: local residency (ORm = 0.06, 95% CI: 0.01–0.34) and perceived higher chance of having unprotected anal intercourse (UAI) in the next six months (ORm = 0.27, 95% CI: 0.09–0.84). In addition, no interaction term between the independent variable and UAI status was found to be statistically significant.

Conclusion

Many sampled never-testers had low intention to take up VCT and were in the pre-contemplation stage of the Transtheoretical Model. Stage-matched promotions are warranted.     

Estimates of the timing of reductions in genital warts and high grade cervical intraepithelial neoplasia after onset of human papillomavirus (HPV) vaccination in the United States

Background

The objective of this study was to estimate the number of years after onset of a quadrivalent HPV vaccination program before notable reductions in genital warts and cervical intraepithelial neoplasia (CIN) will occur in teenagers and young adults in the United States.

Methods

We applied a previously published model of HPV vaccination in the United States and focused on the timing of reductions in genital warts among both sexes and reductions in CIN 2/3 among females. Using different coverage scenarios, the lowest being consistent with current 3-dose coverage in the United States, we estimated the number of years before reductions of 10%, 25%, and 50% would be observed after onset of an HPV vaccination program for ages 12–26 years.

Results

The model suggested female-only HPV vaccination in the intermediate coverage scenario will result in a 10% reduction in genital warts within 2–4 years for females aged 15–19 years and a 10% reduction in CIN 2/3 among females aged 20–29 years within 7–11 years. Coverage had a major impact on when reductions would be observed. For example, in the higher coverage scenario a 25% reduction in CIN2/3 would be observed with 8 years compared with 15 years in the lower coverage scenario.

Conclusions

Our model provides estimates of the potential timing and magnitude of the impact of HPV vaccination on genital warts and CIN 2/3 at the population level in the United States. Notable, population-level impacts of HPV vaccination on genital warts and CIN 2/3 can occur within a few years after onset of vaccination, particularly among younger age groups. Our results are generally consistent with early reports of declines in genital warts among youth.     

Oral and oropharyngeal high-risk HPV prevalence,HIV status,and risk behaviours in a cohort of South African men who have sex with men

Data lag is evident when observing studies focussing on human papillomavirus (HPV) prevalence in the head and neck of men who have sex with men (MSM) in Southern Africa. Sexual behaviours other than anal intercourse, and associated factors are similarly underreported. HPV vaccination has not yet commenced for this population group. One hundred and ninety-nine MSM were enrolled in this study. Participants completed a questionnaire followed by a clinical oral examination, and a rinse-and-gargle specimen in Thinprep^® vials containing Preservcyt^® solution was collected. Detection and genotyping for high-risk HPV were done by an automated system (Abbott^® m2000sp). Six percent of MSM in this cohort had high-risk HPV present in the mouth/oropharynx. This cohort averages 29 years of age, more than half were unemployed (53.3%), and 66.8% were human immunodeficiency virus (HIV) seropositive. The most common sexual practice was anal sex (69.4%) followed by oral sex (28.6%), and by rimming (9.6%). A significant association between oral insertive sex and oral/oropharyngeal HPV status was demonstrated (p = 0.0038; phi coefficient = 0.20). An incidental but significant association between rimming and HIV status was found (p = 0.0046; phi coefficient = 0.19), and HIV seropositive participants had higher oral/oropharyngeal HPV presence. The HPV prevalence of 6% reported in this study is in alignment with global reports. The prevalence of oral/oropharyngeal HPV in this MSM cohort was influenced by sexual practices. MSM participants who practiced rimming appear to be at higher risk of HIV acquisition. Given the transmission routes of HPV in this vulnerable population, vaccination must be urgently studied as an intervention for prevention.     

Primary care providers human papillomavirus vaccine recommendations for the medically underserved: A pilot study in U.S. Federally Qualified Health Centers

Introduction

In the United States, Federally Qualified Health Centers (FQHCs) are safety-net clinics that provide cervical cancer screening and human papillomavirus (HPV) vaccination to medically underserved women, some of whom may be at risk for developing cervical cancer. National guidelines recommend against using screening test results or sexual history to determine vaccine eligibility. Documenting HPV vaccine recommendations and beliefs of primary care providers in FQHCs may aid in promoting evidence-based practices and prioritizing health interventions for vulnerable populations.

Methods

Between 2009 and 2010, we collected data from 98 primary care providers in 15 FQHC clinics in IL, USA using a cross-sectional survey. Questions assessed provider and practice characteristics, HPV vaccine recommendations, and provider's belief about whether their screening and management procedures would change for women who were vaccinated.

Results

93% of providers recommended the HPV vaccine, most frequently for females aged 13–26 years (98%). Some providers reported sometimes to always using HPV test results (12%), Pap test results (7%), and number of sexual partners (33%) to determine vaccine eligibility. More than half of providers (55%) reported they will not change their screening and management practices for vaccinated females, yet believe vaccination will yield fewer abnormal Pap tests (71%) and referrals for colposcopy (74%).

Conclusion

Study providers routinely recommended the HPV vaccine for their patients. However, providers made fewer recommendations to vaccinate females ages 9–12 years (which includes the target age for vaccination) compared to older females, and used pre-vaccination assessments not recommended by U.S. guidelines, such as screening test results and number of sexual partners. In order to maximize the public health benefit of the HPV vaccine to prevent cervical cancer, adherence to guidelines is necessary, especially in settings that provide care to medically underserved women.     

HPV vaccination: Are we initiating too late?

Background

Human papillomavirus (HPV) vaccination is recommended in early adolescence. While limited data suggest that patients frequently delay initiation of the three-dose series, age-based variability in initiation of HPV vaccination and its clinical relevance are not well described. Thus, this study aims to characterize HPV vaccination delay among adolescent and young adult females.

Methods

This retrospective cohort study examined age at HPV vaccination initiation and missed opportunities for receipt of the first vaccine dose (HPV1) among 11–26 year-old females (n = 22,900) receiving care at 16 urban academically-affiliated ambulatory care clinics between 2007 and 2011. Predictors of timely vaccination and post-licensure trends in age at HPV1 receipt were assessed using multivariable logistic regression and a generalized linear mixed model, respectively. Chlamydia trachomatis and Papanicolaou screening before HPV vaccination initiation, as markers of prior sexual experience and associated morbidity, were examined in a subcohort of subjects (n = 15,049).

Results

The proportion of 11–12 year-olds who initiated HPV vaccination increased over time (44.4% [2007] vs. 74.5% [2011], p < 0.01). Initiation rates also improved among 13–26 year-olds. Thus, the mean age at HPV1 receipt remained unchanged between 2007 and 2011 (16.0 ± 2.7 vs. 15.9 ± 4.0 years, p = 0.45). Spanish language was a positive predictor (AOR 1.62, 95% CI 1.05–2.48) of HPV vaccination initiation among 11–12 year-olds in 2011. The majority (70.8–76.4%) of unvaccinated subjects experienced missed vaccination opportunities. Of the subcohort, 36.9% underwent Chlamydia screening before HPV1 receipt (19.1% with ≥1 positive result). Of those with prior Papanicolaou screening (16.6%), 32.1% had ≥1 abnormal result.

Conclusions

These low-income, minority females frequently delayed initiation of HPV vaccination. Many had evidence of prior sexual experience and associated morbidity, placing them at risk of HPV-related complications. Promoting timely HPV vaccination and reducing missed vaccination opportunities are crucial.     

Acceptability of HPV vaccines and perceptions related to genital warts and penile/anal cancers among men who have sex with men in Hong Kong

Men who have sex with men (MSM) are at high risk of contracting HIV and developing genital warts and penile/anal cancers. HPV vaccines are efficacious in preventing such HPV-related diseases among males and WHO recommends its use to young MSM. In a cross-sectional survey, 542 MSM were interviewed. After being briefed about the vaccines’ efficacies and the market price, the prevalence of acceptability of HPV vaccination was 29.2%. Adjusted by significant background variables, perceived high/very high chances of contracting genital warts [adjusted odds ratio (AOR) = 2.04, 95%CI = 1.11–3.72] and penile/anal cancers (AOR = 1.89, 95%CI = 1.09–3.29) among local MSM, perceived moderately high mortality rate of penile/anal cancers (AOR = 1.78, 95%CI = 1.13–2.81), fear toward penile/anal cancers (moderate: AOR = 1.75, 95%CI = 1.07–2.86; high/very high: AOR = 1.82, 95%CI = 1.13–2.92) and disagreement with the statement “MSM in general are not willing to take HPV vaccines” (AOR = 1.82, 95%CI = 1.24–2.68) were associated with the conditional acceptability. Acceptability of this new measure is reasonably high and there are rooms for improvement. Implementation trials to promote HPV vaccination by changing cognitions such as HPV-related risk perceptions, norms and perceptions toward anal/penile cancer are greatly warranted.     

Targeted human papillomavirus vaccination for young men who have sex with men in Australia yields significant population benefits and is cost-effective

BackgroundWe investigated the effectiveness and cost-effectiveness of a targeted human papillomavirus (HPV) vaccination program for young (15–26) men who have sex with men (MSM).MethodsWe developed a compartmental model to project HPV epidemic trajectories in MSM for three vaccination scenarios: a boys program, a targeted program for young MSM only and the combination of the two over 2017–2036. We assessed the gain in quality-adjusted-life-years (QALY) in 190,000 Australian MSM.ResultsA targeted program for young MSM only that achieved 20% coverage per year, without a boys program, will prevent 49,283 (31,253–71,500) cases of anogenital warts, 191 (88–319) person-years living with anal cancer through 2017–2036 but will only stablise anal cancer incidence. In contrast, a boys program will prevent 82,056 (52,100–117,164) cases of anogenital warts, 447 (204–725) person-years living with anal cancers through 2017–2036 and see major declines in anal cancer. This can reduce 90% low- and high-risk HPV in young MSM by 2024 and 2032, respectively, but will require vaccinating ≥84% of boys. Adding a targeted program for young MSM to an existing boys program would prevent an additional 14,912 (8479–21,803) anogenital wart and 91 (42–152) person-years living with anal cancer. In combination with a boys’ program, a catch-up program for young MSM will cost an additional $AUD 6788 ($4628–11,989) per QALY gained, but delaying its implementation reduced its cost-effectiveness.ConclusionsA boys program that achieved coverage of about 84% will result in a 90% reduction in HPV. A targeted program for young MSM is cost-effective if timely implemented.     

Human papillomavirus vaccination coverage among men who have sex with men—National HIV Behavioral Surveillance,United States, 2017

Men who have sex with men (MSM) are at high risk for infections and diseases caused by human papillomavirus (HPV), many of which are vaccine-preventable. In the United States, routine HPV vaccination has been recommended for adolescent males since 2011. This analysis evaluated self-reported receipt of ≥ 1 HPV vaccine dose by age group and HIV status among adult MSM using 2017 data from National HIV Behavioral Surveillance (NHBS) and compared the proportion vaccinated to prior years. Among 10,381 MSM aged ≥ 18 years, 17.9% of MSM overall and 28.4% of MSM living with HIV reported any HPV vaccination. Among 2,482 MSM aged 18–26 years, 32.8% overall and 51.3% living with HIV reported HPV vaccination. Since 2011, the proportion of MSM aged 18–26 years reporting HPV vaccination has increased over six-fold. As vaccinated adolescents age into young adults, coverage will continue to increase overall, including among MSM.     

Pre-vaccination seroprevalence of 15 human papillomavirus (HPV) types among women in the population-based Slovenian cervical screening program

Objectives

To estimate seroprevalence of 11 high-risk (hr) HPV types and four low-risk (lr) HPV types among 20–64 years old Slovenian women participating in the population-based cervical cancer screening program.

Methods

Serum samples from 3259 women were tested for HPV type-specific antibodies with a multiplexed pseudovirion-based serological assay (PsV-Luminex).

Results

Seropositivity for any of the 15 HPV types was 65.7%, any of the 11 hr-HPV types 59.2%, and any of the four lr-HPV types 33.1%. Antibodies against at least one of the four vaccine HPV types (HPV 6, 11, 16, 18) were detected in 40.8% women. Among hr-HPV types, seropositivity was highest for HPV 16 (25.2%) and among lr-HPV types for HPV 6 (19.1%). Age-specific HPV16 seropositivity was highest among 30–39 years old (29.6%) and decreased with increasing age to 14.0% among 60–64 years old.

Conclusion

The lifetime sexual exposure to genital HPV types is substantial, emphasising the need for HPV vaccination.     

Human papillomavirus (HPV) vaccination coverage in young Australian women is higher than previously estimated: Independent estimates from a nationally representative mobile phone survey

Background

Accurate estimates of coverage are essential for estimating the population effectiveness of human papillomavirus (HPV) vaccination. Australia has a purpose built National HPV Vaccination Program Register for monitoring coverage, however notification of doses administered to young women in the community during the national catch-up program (2007–2009) was not compulsory. In 2011, we undertook a population-based mobile phone survey of young women to independently estimate HPV vaccination coverage.

Methods

Randomly generated mobile phone numbers were dialed to recruit women aged 22–30 (age eligible for HPV vaccination) to complete a computer assisted telephone interview. Consent was sought to validate self reported HPV vaccination status against the national register. Coverage rates were calculated based on self report and weighted to the age and state of residence structure of the Australian female population. These were compared with coverage estimates from the register using Australian Bureau of Statistics estimated resident populations as the denominator.

Results

Among the 1379 participants, the national estimate for self reported HPV vaccination coverage for doses 1/2/3, respectively, weighted for age and state of residence, was 64/59/53%. This compares with coverage of 55/45/32% and 49/40/28% based on register records, using 2007 and 2011 population data as the denominators respectively. Some significant differences in coverage between the states were identified. 20% (223) of women returned a consent form allowing validation of doses against the register and provider records: among these women 85.6% (538) of self reported doses were confirmed.

Conclusions

We confirmed that coverage rates for young women vaccinated in the community (at age 18–26 years) are underestimated by the national register and that under-notification is greater for second and third doses. Using 2011 population estimates, rather than estimates contemporaneous with the program rollout, reduces register-based coverage estimates further because of large population increases due to immigration since the program.     

Randomized controlled trial of two dosing schedules for human papillomavirus vaccination among college age males

Background

Quadrivalent human papillomavirus (HPV) vaccine, for protection against sexually transmitted HPV infection, is licensed for females and males 9–26 years on a 3-dose schedule (0, 2, and 6 months; Standard schedule). Vaccine uptake has been low and catch-up vaccination of older adolescents using an alternate dosing schedule may increase coverage. This study tested the non-inferiority of the immunogenicity of an alternate dosing schedule (0, 2, 12 months) among college age males.

Methods

220 18–25 year old males were randomly assigned to Standard or Alternate schedules. Blood samples were drawn immediately before Dose 1 and 2–6 weeks after Dose 3 and analyzed for antibody titers using a Luminex immunoassay. A value <1.5 for the upper 95% confidence interval (CI) bound of the Standard to Alternate schedule geometric mean titer (GMT) ratio was deemed non-inferior.

Results

Participants averaged 21.3 years old; 19.1% were non-white; completion rate was 93%. The anti-HPV titers for the Alternate schedule group were non-inferior to those of Standard schedule group for all four HPV vaccine virus types. Our results also demonstrated superiority of the Alternate schedule group for all four HPV vaccine virus types.

Conclusion

A delayed third dose at 12 months is immunologically non-inferior and superior for four HPV virus types. Using an alternate dosing schedule offers more flexibility to receive the 3-dose HPV vaccine and may result in higher vaccination rates among college-age males.     

Implementation of a hepatitis A/B vaccination program using an accelerated schedule among high-risk inmates,Los Angeles County Jail, 2007–2010

Background

The Centers for Disease Control and Prevention recommend vaccination for men who have sex with men (MSM) and injection drug users against hepatitis A and B. This study is the first report of a hepatitis vaccination program in a United States jail with a combined vaccine using an accelerated schedule. Los Angeles County has the largest jail system in the nation and Men's Central Jail (MCJ) is the largest facility within that system. MCJ includes a unit for self-identified MSM, where approximately 2700 inmates are housed per year.

Methods and findings

Starting in August 2007, a combined hepatitis A and B vaccine was offered to all inmates housed in this special unit. Using an accelerated schedule (0-, 7-, 21–30 days, 12-month booster), a total of 3931 doses were administered to 1633 inmates as of June 2010. Of those, 77% received 2 doses, 58% received 3 doses, and 11% received the booster dose. Inmates who screened positive for a sexually transmitted infection in this unit were 1.3 times more likely to be vaccinated (95% CI 1.2–1.4) compared to others in the same housing unit who screened negative.

Conclusions

Hepatitis vaccination initiatives can be successfully implemented in an urban jail among an extremely high-risk population using the accelerated, combined hepatitis A/B vaccine. Ours may be a useful model for other programs to vaccinate incarcerated populations.     

Utilization of administrative data to assess the association of an adolescent health check-up with human papillomavirus vaccine uptake in Germany

Background

In Germany, 3-dose human papillomavirus (HPV) vaccination is recommended for 12–17 year-old females. Countrywide monitoring of HPV vaccination coverage (VC) does not exist, but small-scale surveys suggested suboptimal uptake. There is currently no concerted implementation strategy in place, and approaches for improved vaccine delivery are needed. Our objectives were to analyze health insurance claims data to estimate HPV VC in the target population and to assess the association of the routine adolescent health check-up ‘J1’ (offered to 12–14 year-olds) with HPV vaccine uptake.

Methods

We sampled a subset of 12–16 year-old females from claims data in 15 of the 16 German federal states. Sampling was based on documented physician contacts flanking the follow-up period 2008–2012. We reconstructed age- and region-stratified histories of individual-level HPV vaccination series and J1 utilization and calculated country-level estimates.

Results

The study sample represented 54% (n = 1.04 million) of the total target population. VC estimates for starting (and completing) HPV vaccination series ranged from 6.1% (1.2%) among 12-year-olds to 47.6% (36.2%) among 16-year-olds. J1 utilization was 50% at maximum. In J1-attendees, 42.0% had received ≥1 vaccine doses, translating into a significant association of J1 utilization and vaccine uptake with a 6.9-fold higher likelihood in 12-year-olds and 1.4-fold higher likelihood in 16-year-olds of receiving HPV vaccination.

Conclusion

HPV VC in Germany is low. Adolescent check-up J1 is associated with increased and accelerated HPV vaccine uptake securing immunization before sexual debut and should be used as a tool to improve VC in the target population. However, J1 utilization is only moderate and more than half of attendees had not received HPV vaccination, which represents a substantial proportion of missed opportunities. This indicates that J1 needs both further promotion through legislative structures already in place for other health check-ups and more awareness as an opportunity to offer HPV vaccinations.