Parental acceptance of Human Papillomavirus vaccines

OBJECTIVE: To determine whether parents would accept Human Papillomavirus (HPV) vaccination for their children and which variables may influence their decision, including knowledge about cervical cancer and HPV. STUDY DESIGN: Three hundred and fifty-six parents of children aged 10-12 years were interviewed regarding the acceptance of an HPV vaccine for their children and their knowledge of HPV and cervical cancer. All data were recorded anonymously. Results were compared using the chi(2)- and the Mann-Whitney test. RESULTS: HPV vaccination would be accepted by 88% of the parents, preferably when the child is aged 10-12 years. Parents of children who received all the vaccinations of the National Vaccination Programme accepted HPV vaccination significantly more. Less than a third of all parents had heard of HPV, and 14% were aware of the causal relationship of HPV and cervical cancer. Knowledge of HPV and cervical cancer, religion, age, education, and marital status did not show any significant relation with HPV vaccine acceptance. CONCLUSIONS: A majority of the parents would accept HPV vaccination. HPV vaccine acceptance seems to be dependent on vaccine acceptance in general, even more than on knowledge of HPV and its causal relation with cervical cancer. However, parents requested more information about cervical cancer, HPV, and HPV vaccination, before the HPV vaccine is introduced.     

Change in knowledge of women about cervix cancer,human papilloma virus (HPV) and HPV vaccination due to introduction of HPV vaccines

Objectives

Test knowledge of HPV, cervix cancer awareness and acceptance of HPV vaccination of women now and a year ago.

Study design

Questionnaires were filled out by 305 women visiting four gynaecologists of the Regional Hospital Heilig Hart, Tienen, Belgium during two subsequent weeks. Fisher T or Chi² were used as statistical methods to compare the data with the survey of 381 women exactly one year before.

Results

Knowledge about HPV as a cause of cervix cancer and the presence of a vaccine rose from roughly 50% in 2007 to over 80% in 2008 (p < 0.0001). Level of education and having daughters, sons or no children no longer influenced the level of knowledge or willingness to accept the vaccine. Most parents favor the age group 12–16 years as an ideal time for vaccination. In contrast with the 2007 survey, women below 26 years had now acquired almost equivalent knowledge to older women about the virus, cervix cancer and the vaccine, but they were far less likely to accept the vaccine due to its cost, unless it would be reimbursed (OR 4.2 (1.6–11) p = 0.0055).

Conclusion

One year after introduction of the first two HPV vaccines, over 75% of women attending an ambulatory gynaecology clinic know HPV causes cervix cancer and that you can get vaccinated against it. Compared with a year earlier, young and lower educated women had dramatically improved their knowledge. However, women below 26 years are less prepared to pay the cost for vaccination if it is not reimbursed.     

Knowledge and interest of Turkish women about cervical cancer and HPV vaccine

OBJECTIVE: We aimed to evaluate the knowledge and interest level of Turkish women about HPV, HPV vaccines and cervical cancer using a questionaire. METHOD: A 25-item questionnaire was distributed to women in three different cities located in separate sociocultural locations. RESULTS: At the closure of the study 143 women responded and returned the survey. Of the participants 62.2% (89) had a university degree, 36.4% (52) a high school education, and 1.4% (2) had lower school degrees; 98.5% of the women would consent to have their daughter vaccinated for HPV and 94.7% would consent to have their son vaccinated if vaccine provided prevention against cancer and related diseases. However in both cases women gave importance to the "cost" - unless vaccine could be free. On logistic regression analyses none of the variables (i.e., questions) in the survey predicted women's willingness to accept the vaccine for themselves or their children. CONCLUSIONS: Women in Turkey would be willing to have themselves and their children receive HPV vaccine against cervical cancer and related diseases.     

Ethnically diverse female university students’ knowledge and attitudes toward human papillomavirus (HPV), HPV vaccination and cervical cancer

Objective

Cervical HPV is the most common sexually transmitted disease among college-age women. This study aimed to assess knowledge and attitudes towards HPV infection, HPV vaccination and cervical cancer among female university students, to provide insight into development of HPV educational information.

Study design

A cross-sectional survey using a convenience sample. A total of 1083 ethnically diverse female students attending a public university were approached and 650 were interviewed.

Results

Knowledge regarding HPV, HPV vaccination, cervical screening and cervical cancer risk factors was remarkably poor. Across the sample, the mean total knowledge score (14-item) was only 3.25 (S.D. ±2.41; 95% CI 3.07–3.44). Only 10.3% had heard of the newly released HPV vaccine. Approximately 48% of participants indicated an intention to receive an HPV vaccine. Intention to receive an HPV vaccine was significantly associated with knowledge of HPV and genital warts (OR 1.53; 95% CI 1.25–1.88), and knowledge of cervical screening and cervical cancer risk factors (OR 1.21; 95% CI 1.11–1.33). Of those who refused HPV vaccination, 50.9% doubted the safety and efficacy of the new vaccine, and 41.5% perceived themselves as not at risk of HPV infection.

Conclusion

The findings suggest that providing education about the etiology of cervical cancer and the HPV link is an essential component to enhance HPV vaccine uptake.     

The prevalence and significance of high-risk human papillomavirus DNA test in southern Malaysia and Singapore

Aim of Study: To investigate the prevalence of high-risk human papillomavirus (HPV) and its associated cytological abnormalities among women attending cervical screening clinics in southern Malaysia and Singapore.
Method: Laboratory results of Hybrid Capture-II (Digene) HPV DNA and liquid-based cytology tests of consecutive women who had screening performed between January 2004 and December 2006 were studied retrospectively.
Results: Of 2364 women studied, the overall prevalence of high-risk HPV DNA detection rate was 25.6%. The prevalence peaked at 49.1% for women between 20 and 24 years old and declined to 23% among women between the age of 30 and 49 years. A small second peak of prevalence rate of 30% was observed among women above the age of 50 years old. 76.1% of the high-risk HPV infection regressed within the study period. An incidence infection rate of 16% was noted among a small group of women who had a second HPV DNA test. A total of 1153 women had both the HPV DNA and the cytology tests. Cytological abnormality (ASCUS or more) was detected in 8.9% in HPV DNA-positive group and in 3.1% in HPV DNA-negative group ( P  < 0.001). The risk ratio for HSIL was 9.8 for HPV-positive women compared to HPV-negative women. The prevalence of cytological abnormalities increased with increasing age of the women.
Conclusion: The epidemiology and clinical impact of high-risk HPV infection for women in Southern Malaysia and Singapore were indistinguishable from experience elsewhere. The apparent moderately high incidence of cervical cancer was explainable by suboptimal screening program.     

A study of women's knowledge regarding human papillomavirus infection, cervical cancer and human papillomavirus vaccines

AIMS: Human papillomavirus (HPV) infection is a common sexually transmitted viral infection and is associated with the development of cervical cancer. HPV vaccines are now undergoing phase 3 clinical trials in Australia. It is likely that an HPV vaccine will become licensed for use in the near future. METHODS: Ninety women aged 18-30 years from three different groups (those attending a dysplasia clinic, a local university health service and participants currently involved in a phase 3 HPV vaccine trial) completed a questionnaire assessing their knowledge base regarding HPV infection, cervical cancer, Pap tests and HPV vaccines. RESULTS: Respondents demonstrated good understanding of the Pap test and interpretation of an abnormal result. Most respondents (89%) had heard of HPV and attributed a number of different clinical symptoms to infection. For women who had not heard of an HPV vaccine, 79% of respondents stated that the most common resource they would use to obtain further information is their general practitioner. DISCUSSION: Many women do not understand the risk factors for HPV infection, the clinical problems it may cause and the potential long-term complications of infection. Few women have heard of a HPV vaccine, but most women surveyed would approach their general practitioner for more information if one became available. CONCLUSION: This study highlights the need for further education regarding HPV infection and the potential long-term complications such as cervical cancer. It also demonstrates that education of general practitioners regarding an HPV vaccine is essential, as this is the most likely resource women will use to obtain further information in the future.     

The epidemiological and economic impact of a quadrivalent human papillomavirus vaccine (6/11/16/18) in the UK

Objective  To assess the potential epidemiological and economic impact of a prophylactic quadrivalent human papillomavirus (HPV) (6/11/16/18) vaccine for preventing cervical cancer, cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3), CIN1 and genital warts.
Design  Cost-utility analysis.
Setting  UK.
Population  Female and male UK population 12 years or older.
Methods  We adapted a previously developed multi-HPV type dynamic transmission to compare four female vaccination strategies, routine vaccination at age 12 years, and routine vaccination at age 12 years combined with temporary catch-up vaccination at ages 12–14, 12–17 and 12–24 years.
Main outcomes measures  Costs, cases avoided, incremental cost per quality-adjusted life year (QALY).
Results  The model projected that at year 100, each vaccination strategy could reduce the number of HPV 6/11/16/18-related cervical cancer, CIN2/3, CIN1 and genital wart cases among women by 86, 85, 79 and 89% respectively. Over 25 years, routine vaccination at age 12 years combined with a 12- to 24-year-old catch-up programme was the most effective strategy, reducing the cumulative number of cases of cervical cancer, CIN2/3, CIN1 and genital warts by 5800, 146 000, 28 000, and 1.1 million respectively. Over 100 years, the incremental cost-effectiveness ratios across all strategies ranged from £5882 to £11,412 per QALY gained.
Conclusion  In the UK, a quadrivalent HPV vaccination programme that includes a catch-up strategy can reduce the incidence of cervical cancer, CIN and genital warts at a cost per QALY ratio within the range typically regarded as cost-effective.     

Human papillomavirus (including vaccination)

Human papillomavirus (HPV) is responsible for 99.7% of cervical cancer. Worldwide, cervical cancer causes more deaths than any other cancer, almost two per minute. Over 200 types of HPV have been identified. HPV is transmitted by skin-to-skin contact. Most HPV infections are cleared by the immune system; persisting infections can cause intra-epithelial neoplasia and invasive disease. Prophylactic HPV vaccines have been developed and prevent disease caused by the included HPV types. Current vaccines could prevent 70–75% cases of cervical cancer. The UK, in 2008 added HPV vaccination to the national immunization programme. The vaccines are safe and well tolerated. It is likely that the benefits will be seen over a 15–20 year period. Tests for HPV have been developed and are being evaluated as to their possible role in clinical practice. Research is ongoing regarding therapeutic HPV vaccination and improving prophylactic vaccines to prevent more cases of cancer.     

Human papillomavirus infection: an old disease, a new vaccine

Human papillomavirus (HPV) infection is common and causes a wide spectrum of disease. With recent advances in the development of prophylactic HPV vaccines, it is likely that these will be licensed for use in the near future. This review focuses on the science behind HPV vaccines, published clinical trial results for both prophylactic and therapeutic HPV vaccines, important issues relevant to implementation and cost-effectiveness models of HPV vaccination programs. It may be that an HPV vaccine that protects against the complications of HPV infection such as cervical cancer will be one of the most significant public health initiatives of this decade.     

Human papillomavirus update (including vaccination)

Human papillomavirus (HPV) is responsible for 99.7% of cervical cancer. Worldwide, cervical cancer causes more deaths than any other cancer, around one every two minutes. In the not so distant future cervical cancer may cause more deaths globally per year, (275,000 in 2008), than maternal deaths, (358,000 in 2008). Over 200 types of HPV have been identified. HPV is transmitted by skin-to-skin contact. Most HPV infections are cleared by the immune system; persistent infection may cause intraepithelial neoplasia and invasive disease.Prophylactic HPV vaccines prevent disease caused by the included HPV types and potentially prevent 70–75% cases of cervical cancer. The UK added HPV vaccination to the national immunization programme in 2008. The vaccines are safe and well tolerated. It is likely that the benefits will be seen over a 15–20 year period.Tests for HPV have been developed and are being evaluated as to their possible role in clinical practice.Research is ongoing regarding therapeutic HPV vaccination and second generation prophylactic vaccines to prevent more cases of cancer.     

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.     

Attitudes about human papillomavirus vaccine among family physicians

STUDY OBJECTIVE: Human papillomavirus (HPV) vaccines will soon be available for clinical use, and the effectiveness of vaccine delivery programs will depend largely upon whether providers recommend the vaccine. The objectives of this study were to examine family physicians' attitudes about HPV immunization and to identify predictors of intention to recommend immunization. DESIGN: Cross-sectional survey instrument assessing provider and practice characteristics, knowledge about HPV, attitudes about HPV vaccination, and intention to administer two hypothetical HPV vaccines. PARTICIPANTS: Surveys were mailed to a national random sample of 1,000 American Academy of Family Physicians (AAFP) members. MAIN OUTCOME MEASURE: Intention to administer two hypothetical HPV vaccines (a cervical cancer/genital wart vaccine and a cervical cancer vaccine) to boys and girls of different ages. RESULTS: One hundred fifty-five surveys (15.5%) were returned and 145 were used in the final sample. Participants reported higher intention to recommend both hypothetical HPV vaccines to girls vs. boys (P < 0.0001) and to older vs. younger adolescents (P < 0.0001). They were more likely to recommend a cervical cancer/genital wart vaccine than a cervical cancer vaccine to boys and girls (P < 0.001). Variables independently associated with intention (P < 0.05) included: female gender of provider, knowledge about HPV, belief that organizations such as the AAFP would endorse vaccination, and fewer perceived barriers to vaccination. CONCLUSIONS: Female gender, knowledge about HPV, and attitudes about vaccination were independently associated with family physicians' intention to recommend HPV vaccines. Vaccination initiatives directed toward family physicians should focus on modifiable predictors of intention to vaccinate, such as HPV knowledge and attitudes about vaccination.     

Prophylactic human papillomavirus vaccines: the beginning of the end of cervical cancer

Persistent infection with one of the oncogenic human papillomavirus (HPV) types is a necessity for the development of cervical cancer. By HPV vaccination, cervical cancer could become a very rare disease. Two types of HPV vaccines can be distinguished: (i) therapeutic vaccines which induce cellular immunity targeted against epithelial cells infected with HPV and (ii) prophylactic vaccines inducing virus-neutralizing antibodies protecting against new but not against established infections. At present, several vaccines have been developed and tested in clinical trials. The vaccines are generally well tolerated and highly immunogenic. The current clinical data indicate that prophylactic vaccines are very effective against new persistent infections and the development of cervical intraepithelial lesions. The protection is type specific. However, the follow-up of the vaccination trials is still short. The effect of HPV vaccines on future cancer incidence will only be known after decades of follow-up. This article will address the status of recently terminated phase II and currently running phase III trials with prophylactic HPV vaccines.     

The use of vaccines in treating cervical cancer: present status and future prospects

Abstract. Onon TS, Kitchener HC. The use of vaccines in treating cervical cancer: Present status and future prospects.
HPV types are carcinogenic agents in cervical cancer. This view is supported by epidemiological and biological evidence. The oncogenic products and capsid proteins of high risk HPV types are potential targets against which effective immunity may be generated by vaccination. Both therapeutic and prophlylactic immunisation are potential strategies to deal with the widespread problem of HPV infection and possibly established cervical neoplasia. Clinical trials are now underway to evaluate candidate vaccines.     

Healthcare providers’ perspectives on the acceptability and uptake of HPV vaccines in Zimbabwe

Background: Human papillomavirus (HPV) vaccines are a critical strategy in the prevention of cervical cancer, especially in countries like Zimbabwe where cervical cancer screening rates are low. In Zimbabwe, cervical cancer is the leading cause of cancer-related deaths in women but the HPV vaccine is not yet widely available. This study examined healthcare providers’: (1) perceptions of current hospital practices and issues in cervical cancer prevention and treatment in Zimbabwe; (2) knowledge of HPV and HPV vaccines; and (3) perspectives on introducing HPV vaccination programs in Zimbabwe, including potential facilitators and barriers to successful implementation.

Method: In-depth semi-structured interviews were conducted at a rural hospital with 15 healthcare providers in Zimbabwe. Interviews included eight main questions and a number of additional probes that reflected the study’s purpose. Data were analyzed using thematic analysis.

Results: Participants reported that women are not consistently being screened for cervical cancer. There were generally low levels of knowledge about HPV and HPV vaccines, but participants asked many questions indicating a desire to learn more. Although they were highly supportive of implementing HPV vaccination programs in Zimbabwe, they also identified a number of likely psychosocial, cultural, and logistical barriers to successful implementation, including cost, vaccine schedule, and hospital infrastructure. However, participants also provided a number of culturally relevant solutions, including education and community engagement.

Conclusion: This study provides insight from healthcare providers about barriers to implementation and possible solutions that can be used by policy makers, practitioners, and other stakeholders to facilitate the successful implementation of forthcoming HPV immunization programs in Zimbabwe.     

Factors influencing acceptance of human papillomavirus vaccine among young female college students in Thailand

ObjectiveTo determine knowledge and beliefs related to human papillomavirus (HPV), cervical cancer, and vaccination among young Thai women, and thereby identify independent predictors associated with acceptance of HPV vaccination.MethodsA convenience sample of 747 young women aged 18–24 years was recruited from universities and colleges located in the upper northern region of Thailand. An online questionnaire was performed to assess demographics; HPV and cervical cancer-related health characteristics; and knowledge and beliefs toward HPV and cervical cancer. Logistic regression analysis was used to determine independent predictors of HPV vaccine acceptance.ResultsKnowledge about HPV and cervical cancer was moderate. The mean total knowledge score was 7.5 ± 3.8. Acceptance of the HPV vaccine was significantly associated with having received a recommendation for vaccination (odds ratio [OR] 2.12; 95% CI, 1.22–3.68); perceived susceptibility to disease (OR 1.37; 95% CI, 1.22–1.52); perceived benefits of vaccination (OR 1.33; 95% CI, 1.19–1.49); and perceived seriousness of disease (OR 0.90; 95% CI, 0.81–1.00).ConclusionUnderstanding variables associated with acceptance of HPV vaccination may guide immunization initiatives and so increase the uptake rate among young Thai women.     

Are women ready for the HPV vaccine?

OBJECTIVE: An HPV (human papillomavirus) vaccine will be available soon. Because vaccination for both boys and girls will be critical to reduce the incidence of this disease, we evaluated the willingness of women to accept the HPV vaccine and to consent to having their children vaccinated. METHODS: A 20-item questionnaire was distributed to women who had children between the ages of 8 and 14 years, the likely age range of the children who will be targeted to receive the vaccine. RESULTS: 200 women completed surveys. The median age for the respondents was 34.4 years (range, 23-53 years). 77% of the women surveyed would be willing to accept an HPV vaccine for themselves. 67% who had a daughter (n = 156) and 66% who had a son (n = 137) would consent to have their child vaccinated. Those not accepting the vaccine cited the risk of unknown adverse effects or their current lack of sexual activity. Women who would not consent to have their children vaccinated cited the risk of unknown adverse effects and their belief that their children are not sexually active. Male children not directly benefiting from the vaccine were also a reason for not considering the vaccine for sons. A history of an abnormal Papanicolaou smear was not associated with willingness to accept the vaccine. CONCLUSIONS: This pilot study demonstrated a willingness of women to accept the HPV vaccine for themselves and their children. Gynecologists and gynecologic oncologists must focus not only on the diagnosis and treatment of cervical cancer but also on its prevention.     

HPV疫苗在中国的应用现状

目前,在中国HPV疫苗接种覆盖率仍极低,主要原因可能与民众对疫苗种类的选择、接种的最佳年龄及疫苗接种程序与价格等多种因素存在困惑相关。文章就宫颈癌的病因学、HPV疫苗获批情况、在国外的应用现状以及中国HPV疫苗使用现状及面临挑战等有关问题予以简述,并提倡妇产科专家及疾控专家积极推动宫颈癌的防控,使低龄女孩及其家长了解宫颈癌及HPV疫苗相关知识,使低龄女孩尽早接种HPV疫苗,提高HPV疫苗接种覆盖率,为全面消灭宫颈癌而共同努力。     

Education about human papillomavirus and human papillomavirus vaccines in adolescents

PURPOSE OF REVIEW: The purpose of this article is to review recent literature that may help guide the development of effective, evidence-based strategies to educate adolescents about human papillomavirus (HPV) and HPV vaccines. Educational strategies are essential, given several new and highly effective technologies to prevent HPV and related diseases such as cervical cancer. RECENT FINDINGS: Although little has been published regarding adolescent knowledge about HPV and HPV vaccines, studies conducted primarily in adult women demonstrate that knowledge generally is poor. Studies of adolescent attitudes about HPV vaccines have identified several modifiable factors associated with intention and confidence in one's ability to receive the vaccine, including higher perceived severity of cervical cancer and fewer barriers to vaccination. Studies of clinician attitudes about HPV vaccines have demonstrated that although clinicians generally support vaccination, some report concerns; for example, adolescents may practice riskier sexual behaviors after vaccination. Studies also show that clinicians believe that educational materials developed specifically for adolescents are essential. SUMMARY: The recent literature on adolescent knowledge about HPV and attitudes about HPV vaccines supports the importance of designing developmentally appropriate educational materials for adolescents about HPV and HPV vaccines, and provides guidance for the development of key educational messages.