Patterns of cervical coinfection with multiple human papilloma virus types in a screening population in Denmark

Patterns of cervical human papillomavirus (HPV) infection suggest that HPV genotypes are not independent of each other. This may be explained by risk factors common to all HPV infections, but type-specific biological factors may also play a role. This raises the question of whether widespread use of the quadrivalent vaccine (covering HPV6, 11, 16, 18) may indirectly affect the prevalence of any non-vaccine types. Routine screening samples from 5014 Danish women were tested for 35 HPV genotypes (including 13 high-risk) using the Genomica CLART^® HPV2 kit, which is a low-density microarray based on PCR amplification. Simulation studies were performed both under independence between genotypes and under a common dependence structure as would arise from common risk factors, and simulation results were compared to observed coinfection patterns. Overall HPV prevalence was 37.4%, with multiple infections in 17.9%. For 15 HPV types of primary interest (13 high-risk plus HPV6, 11), almost all pairs occurred more often than expected under independence; 33/105 (31.4%) were statistically significant (p < 0.05 after adjustment for multiple comparisons). The pairwise odds ratios showed significant heterogeneity (Woolf's test p < 0.0001). For simulations based on common dependence, three pairs had observed to expected (O/E) ratios significantly different than 1 (31/68, O/E = 4.20; 51/68, O/E = 2.52; 33/58, O/E = 3.27; all p < 0.05 after adjustment for multiple comparisons). HPV68 occurred in multiple infections nearly four times as often as expected under common dependence (p < 0.005 after adjustment for multiple comparisons). These results indicate some interaction between HPV types, and suggest that common risk factors do not entirely explain the observed HPV coinfection pattern, although no evidence is found that the prevalence of any types not targeted by the quadrivalent vaccine may be indirectly increased or decreased after widespread use of the vaccine.     

Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects

Prophylactic vaccines for human papillomavirus (HPV) are being introduced in many countries for the prevention of cervical cancer, the second most important cause of cancer-related death in women globally. This is likely to have a significant impact on the future burden of cervical cancer, particularly where screening is non-existent or limited in scale. Previous research on the challenges of vaccinating girls with the HPV vaccine has focused on evidence from developed countries. We conducted a systematic search of the literature in order to describe the barriers and challenges to implementation of HPV vaccine in low- and middle-income countries. We identified literature published post-2006 to September 2012 from five major databases. We validated the findings of the literature review with evidence from qualitative key informant interviews. Three key barriers to HPV vaccine implementation were identified: sociocultural, health systems and political. A linked theme, the sustainability of HPV vaccines programmes in low- and middle-income countries, cuts across these three barriers. Delivering HPV vaccine successfully will require multiple barriers to be addressed. Earlier research in developed countries emphasised sociocultural issues as the most significant barriers for vaccine roll-out. Our evidence suggests that the range of challenges for poorer countries is significantly greater, not least the challenge of reaching girls for three doses in settings where school attendance is low and/or irregular. Financial and political barriers to HPV vaccine roll-out continue to be significant for many poorer countries. Several demonstration and pilot projects have achieved high rates of acceptability and coverage and lessons learned should be documented and shared.     

Singaporean men's knowledge of cervical cancer and human papillomavirus (HPV) and their attitudes towards HPV vaccination

Little is known of men's knowledge of cervical cancer and its links with human papillomavirus (HPV), or of their attitudes and beliefs about HPV vaccination. This is despite men's sexual behaviour contributing to HPV transmission and their potential role in deciding whether their children are vaccinated against HPV. To address this, a comprehensive survey was conducted in Singapore where plans are underway for an HPV vaccination program. A representative sample of 930 Singaporean men was found to have moderate knowledge of cervical cancer but poor knowledge and awareness of HPV. Although these men showed strong support for HPV vaccination, overall findings highlight the importance of including men in education campaigns that aim to decrease the incidence of cervical and other HPV-related cancers and to increase the uptake of HPV vaccination.     

Literature review of human papillomavirus vaccine acceptability among women over 26 years

Vaccines for the human papillomavirus (HPV) are currently licensed for females, ages 9 through 26 years old in the U.S., and for adult women up to 45 years in some countries such as Australia. As licensure for adult women, over 26 years, is sought in other countries, it will be important to determine the acceptability to them. We reviewed the available articles on adult opinions and acceptability of vaccinating women against HPV. Predictors of acceptability included barriers, knowledge, risk, age, and marital status. Overall, acceptability rates were high, if adequate information was given and the cost was affordable.     

Knowledge differences between male and female university students about human papillomavirus (HPV) and cervical cancer: Implications for health strategies and vaccination

Knowledge about HPV and cervical cancer (CC) depends on several factors such as gender and education, which brings implications for health strategies and vaccination. A survey was conducted in Portugal with a representative sample of 1706 university students. Only 55.4% (n = 945) had already heard of HPV, although 88.3% (n = 834) from that know that is a risk factor for CC. 89% students (n = 841) wants to be vaccinated against it, but only 13.8% stated as main reason to be vaccinated “prevention of the disease”. Mean scores of knowledge were calculated. Statistical differences were found, regarding “CC knowledge”, in gender (p < 0.001) and between health sciences schools and non-health sciences schools (p < 0.001). Differences regarding the study area in “knowledge and beliefs of HPV” (p < 0.001) and in “relation between HPV and CC” (p < 0.001) were found. Therefore, these differences may help to develop effective strategies that lead to decline CC incidence and mortality.     

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.     

清远市中心区域妇女人乳头瘤病毒感染现状调查与分析

目的了解广东清远地区妇女人乳头瘤病毒(HPV)感染基因型的分布情况,为本地区宫颈癌的防治提供科学依据。方法采用核酸分子快速导流杂交基因芯片分型技术对23 983例就诊者进行下生殖道HPV 21种基因亚型的分型检测。对其中部分HPV感染者进行宫颈液基细胞检查和(或)在阴道镜下取组织活检进行病理检查。结果 23 983例标本中,HPV阳性为5 372例,阳性率为22.40%,21种基因亚型均有检出,感染率前五位的HPV基因亚型由高到低依次为HPV-16(6.02%)、52(4.46%)、56(2.68%)、11(2.25%)、66(1.86%)。在5 372例阳性标本中,单一基因亚型感染的3 966例,占73.83%;多重感染的为1 406例,比例为26.17%。HPV感染者高峰年龄段为26⁴5岁。随宫颈疾病及癌前病变程度的加重,高危型HPV感染率均显著上升,CINⅡ、CINⅢ和侵润癌均为100%。结论本地区宫颈炎患者的HPV感染率较高,以16、52、56亚型为主。HPV感染高发于中青年妇女,宫颈病变程度与HPV感染密切相关,长期持续高危型HPV感染可能导致宫颈癌。进行HPV感染者长期的跟踪随访和预后判断,对降低宫颈癌的发病率等有着重要的意义。     

Parental Response to Human Papillomavirus Vaccine Availability: Uptake and Intentions

This study examined parental responses to the quadrivalent human papillomavirus (HPV) vaccine approximately 2 years post-licensure. Correlates of vaccine uptake included daughter age, physician recommendation, and parental knowledge, beliefs, and attitudes. Correlates of vaccination intentions were consistent with previous research. Findings can inform future efforts aimed at promoting HPV vaccination.     

宫颈癌不同治疗方法对HPV病毒载量的影响

目的:探讨不同分期及组织分化的宫颈癌患者HPV病毒载量及宫颈癌不同治疗方案对HPV病毒载量的影响。方法:以2007年1月~2010年1月新疆维吾尔自治区人民医院收治的宫颈鳞癌患者227例为研究对象,根据临床分期分为根治性手术治疗、根治性放疗及根治性放疗联合增敏化疗3组。采集患者入院时及治疗后宫颈分泌物,应用HCⅡ方法检测HPV病毒载量。结果:227例宫颈鳞癌患者中,HPV感染率为99.11%,经治疗后复查HPV感染率为57.26%。多样本均数方差分析结果表明,各个期别宫颈癌的HPV病毒载量差别均有统计学意义(P<0.05),高分化与中分化宫颈鳞癌的HPV病毒载量差别无统计学意义(P>0.05),而中分化与低分化宫颈鳞癌及高分化与低分化宫颈鳞癌的HPV病毒载量差别有统计学意义(P<0.05);根治性手术、根治性放疗、根治性放疗联合增敏化疗对宫颈癌患者治疗后HPV病毒载量的影响有统计学差异(P<0.05)。结论:宫颈癌FIGO分期期别越高、组织分化越低,HPV病毒载量越高,根治性手术治疗及联合放化疗能明显降低宫颈癌患者的HPV病毒载量,HPV病毒载量检测可作为宫颈癌的筛查及病情追踪监测的指标。     

Impact of human papillomavirus vaccination on racial/ethnic disparities in vaccine-type human papillomavirus prevalence among 14–26 year old females in the U.S.

BackgroundLow human papillomavirus (HPV) vaccination rates early after introduction, particularly among low income and minority adolescents, may have resulted in disparities in vaccine-type HPV prevalence (types 6, 11, 16, 18). The purpose of this study was to examine racial/ethnic variations in HPV prevalence, and evaluate how HPV vaccination has affected vaccine-type HPV prevalence across time.MethodsThis study was a retrospective analysis of 6 cycles of the National Health and Nutrition Examination Survey (NHANES) data (2003–2014). Results on HPV status from vaginal samples of 14–26 year old females who responded about HPV vaccination were used to determine HPV prevalence. Prevaccine HPV prevalence was compared to post-licensure prevalence. Racial/ethnic comparisons were made across time, and models were developed to examine the role of HPV vaccination in observed variations for vaccine-type HPV prevalence.ResultsAmong 4080 females, 29.7% were black, 25.6% were Mexican American, 8.9% were Hispanic, and 35.8% were white. Compared to prevaccine years (2003–2006), vaccine-type HPV did not decrease until late post-licensure years (2011–2014; 14.2% vs. 5.2%, p < 0.001). Most of the decrease occurred among white females between prevaccine and late post-licensure periods (15.2% vs. 4.1%, p < 0.001). Although a decrease in prevalence was observed among black females during the same periods (16.9% vs. 9.8%, p < 0.05), it was not as large as among white females. Prevalence decreased among Mexican Americans (8.2 vs. 4.0, p > 0.05) during the same periods, but the difference was not significant. Interactions between race and time were significant (p < 0.001), with uneven vaccination between black and white females contributing to the disparities observed.ConclusionsHPV vaccination was low in among black and Mexican American females, which contributed to disparities in HPV prevalence. Increasing vaccination among all adolescents, particularly 11–12 year olds, is important because most children this age will not have been exposed.     

广东省流动人口育龄妇女HPV感染状况调查

目的:对广东省流动育龄妇女进行人乳头瘤病毒(HPV)筛查,为宫颈癌的预防提供依据。方法:应用SELDI-TOF-MS技术对人群进行HPV筛查,并检测16种HPV分型以及分析该群体的年龄、职业、教育程度和性生活史与感染率的关联性。结果:筛查26 766例人群中HPV感染率为6.77%。在各不同的分组中≥55岁组感染率最高(13.29%,P<0.05);商业/服务业组的感染率最高(5.72%,P<0.05);本科组的感染率最高(15.70%,P<0.05);性生活年限高于30年的感染率比其他组别都要高(11.90%,P<0.05);混合型别和单型别的感染也均是性生活年限在30年以上的感染率最高(2.84%和9.09%,P<0.05)。感染HPV型别主要为HPV16(1.39%)、HPV52(1.10%)、HPV58(0.83%)、HPV18(0.69%)。结论:广东省流动育龄妇女HPV感染率与全球总体趋势一致,HPV感染与人群年龄、职业、教育程度和性生活史密切相关,对人群进行HPV感染筛查能有效地防治宫颈癌,有良好的社会经济效益。     

1169例宫颈癌患者人乳头状瘤病毒感染状况分析

目的分析宫颈癌患者人乳头状瘤病毒(HPV)感染状况及其分布规律。方法以2007年1月～2008年12月在浙江省肿瘤医院就诊并经病理学确诊的1169例浸润性宫颈癌患者作为研究对象,采集其宫颈脱落细胞标本,用导流杂交方法(HybriMax)进行21种HPV基因型的分型检测。结果21种HPV基因型中检测到19种,常见的5种基因型为HPVl6、18、58、52、33型;HPV基因型单一感染为77.16%;多重感染为14.54%;其中二重感染12.23%,三重感染1.28%,四重感染0.77%,五重感染0.26%。结论宫颈癌患者常见HPV基因型的分布既符合亚洲地区的分布规律,又有一定的区域性;宫颈癌患者HPV分型检测对HPV疫苗开发、应用具有重大意义。     

外用杀微生物剂预防性传播疾病/艾滋病的可接受性研究进展

2007年联合国艾滋病规划署(UNAIDS)与世界卫生组织(WHO)估计,全世界HIV感染者中46.39%为女性[1].尽管采取了各种预防HIV/AIDS的措施,如使用安全套、减少性伴等,但HIV/AIDS的流行趋势并未减弱,特别是女性感染者数量逐年增加.