Knowledge of Pap smear, HPV and the HPV vaccine and the acceptability of the HPV vaccine by Thai women

Aims: The primary prevention for cervical cancer, a human papilloma virus (HPV) vaccine, has been available in Thailand for almost 3 years. The present study evaluates knowledge about the Papanicolaou (Pap) smear, HPV and the HPV vaccine and focuses on identifying predictors for the acceptability of the HPV vaccine. Methods: A sample of 764 women attending the gynecology clinic at Ramathibodi Hospital, Bangkok, was asked to answer a questionnaire on their personal background, their knowledge of the Pap smear and HPV and the HPV vaccine and the acceptability of the HPV vaccine for themselves and their daughters. Results: Knowledge of the Pap smear (96%) is higher than that of HPV (41%) and the HPV vaccine (36%). Only 40% of participants had previously heard about HPV. The acceptability of the HPV vaccine for participants and their daughters was high, 77% and 84%, respectively. Knowing about HPV increases acceptance for the HPV vaccine (adjusted OR = 1.7, 95% CI = 1.2–2.5, in the participants and OR = 2.3, 95% CI = 1.5–3.6 in their daughters). Participants younger than 45 years old (OR = 2.3 and 95% CI = 1.6–3.4 for themselves; OR = 2.2 and 95% CI = 1.4–3.3 for their daughters) were more likely to accept the vaccination than those aged 45 years old and above. Conclusion: Knowledge about HPV and the HPV vaccine is generally poor in Thai women. However, the acceptability of the HPV vaccine is good. Knowing about HPV and age under 45 years predict the acceptability of the HPV vaccine.     

HPV vaccines and the prevention of cervical cancer

Cervical cancer is the second commonest causes of cancer death among women worldwide. Uniquely amongst human cancers, it is entirely attributable to infection. Persisting infection of anogenital epithelium with one of a limited subset of human papillomaviruses (HPVs) is necessary for the development of cervical cancer. Several recent large clinical trials have shown that prophylactic vaccines, based on PV virus particles produced using recombinant DNA technology, provide long lasting immunity against infection with the incorporated PV genotypes, and against premalignant conditions caused by these infections. Effective deployment of these vaccines, which have excellent safety and efficacy profiles, could eventually reduce the global burden of cervical cancer by up to 70% through universal immunisation of preadolescent girls. Vaccine use will supplement rather than replace cervical cancer screening programs, where these programs already exist.     

中国城市职业女性对人乳头状瘤病毒疫苗认知与接受度调查及健康教育效果评价

目的 了解中国城市职业女性对子宫颈癌、人乳头状瘤病毒（HPV）及HPV疫苗的认知与接受度,同时评价健康教育的作用。方法 采用多中心横断面调查方法,在北京、杭州、长沙、成都和广州5个城市选择16家单位,对职业女性进行健康教育,调查健康教育前后女性对子宫颈癌、HPV及预防性HPV疫苗的认知和态度。结果 2011年8月至11月共调查1 146名职业女性,平均年龄37.03岁（16～67岁）,对子宫颈癌、HPV和HPV疫苗的知晓率分别为95.06 %、27.98 %和12.82 %,仅20.68 %知晓子宫颈癌与HPV持续感染相关。经健康教育后,知晓子宫颈癌与HPV持续感染相关的女性比例（89.26 %）比健康教育前提高3.32倍,差异有统计学意义（χ2＝93.414,P＜0.001）;不愿意给孩子接种疫苗的比例虽有所降低,但仍占19.25 %,主要原因是担心疫苗的安全性（23.52 %）,认为孩子太小,没有患子宫颈癌的危险性（21.92 %）,疫苗还没有大范围推广使用（13.01 %）和担心疫苗的有效性（12.79 %）。结论 我国城市职业女性人群对HPV及疫苗的认知率普遍较低,经健康教育后明显提高,人群对HPV疫苗防治子宫颈癌总体上持积极支持的态度,大部分女性能够接受为孩子接种HPV疫苗,但HPV疫苗的有效性和安全性仍然是公众关注的主要焦点。     

Knowledge of cervical cancer and HPV vaccine post- vaccination among mothers and daughters in Vietnam

Background: Limited human papillomavirus (HPV) related knowledge might be a barrier to future vaccineacceptance. From 2008-2010, PATH conducted an HPV vaccination demonstration project in partnership withthe government immunization program in Vietnam, which included awareness campaigns prior to vaccination.Objective: To assess and compare knowledge and attitudes about cervical cancer and HPV vaccines betweenmothers and daughters, and whether knowledge was associated with vaccination status. Methods: We analyzedHPV-related knowledge and attitude data from mother-daughter paired responses to a cross-sectional householdsurvey. After parents completed the survey, daughters were asked the same questions. We calculated the frequencyof responses for each question and devised a scaled composite measure for knowledge. Results: Participantsbelieved they had received enough information about cervical cancer and HPV vaccines and it was sufficient tomake a decision about vaccination. Fifty percent of the participants knew HPV causes cervical cancer and 80%knew the HPV vaccine prevented cervical cancer. Mothers had more knowledge about cervical cancer and HPVinfection (p<0.01), compared to daughters, who had more vaccine specific knowledge (p<0.01). However, thetotal mean knowledge score was similar for the groups. Girls not fully vaccinated had a lower mean knowledgescore than fully vaccinated girls (p<0.001). Conclusions: Our results suggest that the purpose of the HPVvaccine was clearly messaged; however, some misconceptions about cervical cancer and HPV still exist. Limitedknowledge about the magnitude of cervical cancer, HPV as a cause of cervical cancer, and HPV vaccines mayhave contributed to incomplete vaccination.     

Human papillomavirus vaccine and cervical cancer prevention

Cervical cancer is one of the most common types of cancer in women worldwide, with the highest rates observed in underdeveloped countries. In the last decades, its incidence has decreased after the implementation of screening programs, mainly in developed countries. Iinfection with high-risk oncogenic HPV is associated with precancerous lesions and cervical cancer. Advances in the understanding of the role of HPV in the etiology of high-grade cervical lesions (CIN 2/3) and cervical cancer have led to the development, evaluation and recomendation of two prophylactic HPV vaccines. This review article provides a summary of the studies related with their development and efficacy.     

新疆维吾尔族女性人乳头瘤病毒感染与宫颈癌相关性的流行病学调查

目的　了解新疆维吾尔族女性人乳头瘤病毒（ＨＰＶ）感染及宫颈癌的发病状况,为新疆宫颈癌预防和筛查提供数据。方法　于２００６年采用整群抽样方法选择新疆于田县有性生活、１６～５９岁维吾尔族女性,按年龄分层入组,依次行宫颈液基细胞学检查和ＨＰＶ检测。意义不明的不典型鳞状细胞（ＡＳＣＵＳ）以上或ＨＰＶ阳性者行阴道镜检查及必要的宫颈活检。结果　新疆维吾尔族妇女高危型、低危型和总体ＨＰＶ感染率分别为７.２５％、１.５９％和８.２７％。ＣＩＮⅡ级以上病变和宫颈癌现患率分别为１.９３％和０.２３％。高危型ＨＰＶ在细胞学ＡＳＣＵＳ、鳞状上皮内低度病变（ＬＳＩＬ）和鳞状上皮内高度病变（ＨＳＩＬ）中的比例分别为１３.４６％、６４.７１％和９０.００％;高危型ＨＰＶ在ＣＩＮⅠ、ＣＩＮⅡ、ＣＩＮⅢ和ＩＣＣ的比例分别为６６.６７％、８３.３３％、１００.００％和１００.００％。ＨＰＶ感染率随宫颈病变级别增加有增高趋势,但在ＣＩＮⅡ级以上病变中无统计学差异。结论　新疆维吾尔族女性ＨＰＶ感染率低于我国汉族女性,但宫颈癌现患率高于我国城市汉族女性,低于一些农村汉族女性。新疆维吾尔族女性ＨＰＶ感染率在不同级别宫颈上皮内瘤变中的分布趋势与中国其他地区相似,但同时具有自身民族特征。     

Awareness of cervical cancer and HPV vaccination and its affordability among rural folks in Penang Malaysia

Introduction: As the second most common cancer in women worldwide, cervical cancer causes major health and economic burdens. Recent introduction of HPV immunization program locally has been encouraging but vaccine uptake remains poor. In addition, no study has been conducted to explore the people’s awareness and knowledge on cervical cancer, HPV and its vaccine in a rural setting in Malaysia after the inception of the HPV vaccination program. Objective: This study was conducted to determine the awareness of cervical cancer, HPV vaccination and its affordability among people in a rural area in Malaysia. Method: A cross-sectional study was conducted among 116 participants in a village in Penang. All consenting female villagers aged 13 years and above, and males who were married were interviewed using a questionnaire. Results: Most participants (88.8%) had heard of cervical cancer, however only 29.3% and 42.2% of them had heard of HPV and HPV vaccination respectively. Only 5.2% knew the actual market price for the vaccine. They were willing to pay an average of RM 96.7 (USD $27.7) for the full course of vaccination if it is not given to them for free, whereas the market price is RM1200 (USD $342.85). Conclusion: Awareness among the Malaysian population in a rural setting on HPV and HPV vaccination is low. Educating the public on the infection can help control the illness. Cost of the HPV vaccine is a serious barrier to the success of the vaccination program in Malaysia.     

Human Papillomavirus (HPV) Prevalence and Type Distribution in Urban Areas of Malaysia

Background: Cervical cancer is the third leading cause of death in Malaysia, and Human Papilloma Virus (HPV) is the principal aetiology that is responsible for its development. This study was aimed to determine the prevalence and distribution of HPV types among different age groups, ethnicity, and areas in Malaysia. Materials and Methods: A total of 764 women aged 20-74 years old within the cities of Johor Bahru, Kuala Lumpur, Ipoh, Penang, and Kota Kinabalu underwent both cervical cytological assessment and HPV DNA analysis. Cervical cytology glass slides were prepared using the liquid base technique (Path TEZT TM). HPV DNA was extracted using TANBead® Nucleic Acid Extraction Kit (Taiwan Advanced Nonotech Inc.), then the types were further identified using a DR.HPV Genotyping IVD kit. Results: The prevalence of HPV infection was 14.0% (107/764) with high-risk type at 10.7% (82/764) and low-risk type at 3.27% (25/764). The most common high-risk HPV types were HPV-52, 66, 33, 39, and 58 whereas low-risk HPV types were HPV-6, 40, and 81. The majority of HPV infections (80.37%) were detected in women with normal cytology results. The most prevalent HPV type among Chinese is 33 (n=6) followed by 16, 44, 58, 66 and 68 (n=5). Among Malays, HPV 16 and 51 were the two most prevalent types (n=2). The sensitivity of the HPV DNA test compared to cytology was 100% with a specificity of 88.37%. Conclusion: This study revealed that the most common high-risk HPV type among women living in urban areas in Malaysia is HPV 52, unfortunately which is not the type of infection the current HPV vaccine is covered for protection among females. These findings may contribute beneficial information to health care providers for the appropriate use of HPV vaccine in the prevention of cervical cancer in Malaysia.     

Prevalence and distribution of HPV genotypes among HIV-infected women in Zambia

We screened 145 HIV-infected non-pregnant women at a tertiary care centre in Lusaka, Zambia. Liquid-based cytology and human papillomavirus (HPV) genotyping with PGMY09/11 biotinylated primers (Roche Linear Array HPV genotyping test) maximised sensitivity of cytology and HPV assessments. Among high-risk (HR) types, HPV 52 (37.2%), 58 (24.1%) and 53 (20.7%) were more common overall than HPV 16 (17.2%) and 18 (13.1%) in women with high-grade squamous intraepithelial lesions or squamous cell carcinoma (SCC) on cytology. High-risk HPV types were more likely to be present in women with CD4+ cell counts <200 microl(-1) (odds ratios (OR): 4.9, 95% confidence intervals (CI): 1.4-16.7, P=0.01) and in women with high-grade or severe cervical cytological abnormalities (OR: 8.0, 95% CI: 1.7-37.4, P=0.008). Human papillomavirus diversity in high-grade lesions and SCC on cytology suggests that HPV 16- and 18-based vaccines may not be adequately polyvalent to induce protective immunity in this population.     

Attitudes to HPV vaccination among parents of children aged 12‐15 years—A population‐based survey in Sweden

In this population‐based survey undertaken in Sweden in 2007, we investigated correlates of attitudes to human papillomavirus (HPV) vaccination among parents of children aged 12–15 years. We invited 16,000 parents of girls and 4,000 parents of boys, randomly selected from the Swedish population. Response rates were 70 and 69%, respectively. Multinomial logistic regression models were applied to investigate correlates of acceptability to HPV vaccination. Among studied parents, 76% were willing to vaccinate their child if the vaccine is for free and 63% were willing to vaccinate even if the vaccine comes with a cost. Having heard of HPV was associated with both willingness to vaccinate if the vaccine is free (odds ratio [OR]: 1.42; 95% confidence interval [CI]: 1.21–1.66) and willingness to vaccinate even if the vaccine is not free (OR: 1.96; 95% CI: 1.75–2.20) compared with those who never heard of HPV. Beliefs about vaccine safety and efficacy were also strong correlates of willingness to vaccinate. Parents born outside Europe and those with higher education were less willing to vaccinate if the vaccine is not free. In conclusion, the willingness to vaccinate was reasonably high and cost did not appear to be a major barrier. Information about vaccine safety and efficacy is important and parents need information about HPV and the HPV vaccine.     

Factors determining acceptability of mammography in an Asian population: a study among women in Singapore

Population-based mammographic screening has been shown to beeffective in reducing breast cancer mortality in the West. In Singapore, aproject carried out to determine the effectiveness of implementing such aprogram locally invited 28,000 women between the ages of 50 and 64 years formammography. The current study, which was part of this larger project, wasintended to determine factors contributing to the acceptance of mammographicscreening among women in Singapore. A questionnaire was administeredin-person to 300 attenders and 260 non-attenders. The respondents werecompared with respect to basic demographic characteristics, previouspreventive behavior, informal social support, and attitudes towards earlydetection. We found that screening attenders were more likely to be Chinesethan Malays (14 percent of the population) or Indians (seven percent), and tobe working outside the home (adjusted odds ratio [OR]) = 4.5, 95 percentconfidence interval [CI] = 2.6-7.9). A grea ter proportion of attenders had ahistory of other screening tests such as the Pap smear (OR = 4.7, CI =2.6-8.7 for recent smear compared with never having had a smear). They werealso more likely to indicate a sense of personal susceptibility to cancer,but did not differ from non-attenders in terms of believing in cancerprevention, or of preferring to be told if they did have cancer. Thestrongest independent predictor of attendance, however, was encouragement byher spouse or family member. For women in this population to be persuadedeffectively to participate in mammographic screening, it would be importantto convince family members of the benefits of the test. At the same time,education targeted specifically at women of the appropriate age group shouldaddress the issue of the personal relevance of screening for breastcancer.     

Awareness about Human Papillomavirus Vaccine and Its Uptake among Women from North India: Evidence from a Cross-Sectional Study

Objective: This study aims to estimate the prevalence of human papillomavirus (HPV) vaccine usage and determine the factors for awareness about HPV vaccine among women in reproductive age group. Methods: This is a cross-sectional survey under a cervical cancer prevention study. The sample size was 1020 women, aged 15-49 years [550 in Delhi and 470 in Rohtak]. Bivariate analysis and Fisher exact test along with binary logistic regression analysis were used to determine the factors for awareness. Result: About 18.0 % [Delhi: 24.2 % and Rohtak: 10.9 %] of the respondents had heard about the vaccine against cervical cancer. The women aged more than 30 years [AOR: 1.35; CI: 0.94, 1.94] were more likely to be aware of cervical cancer vaccine as compare to women of 30 years and less. However, the women from Rohtak [AOR: 0.90; CI: 0.48, 1.66] were less likely to be aware of vaccine against cervical cancer in reference to women aged 30 years and more [AOR: 1.61; CI: 1.01, 2.56] from Delhi. About 0.6 % [Delhi: 1.1 % and Rohtak: 0.0 %] of the respondents had received HPV vaccine. Conclusion: Women tend to have limited knowledge about cervical cancer vaccine and immunisation practices. The women’s demographic makeup varied significantly between the two sites, i.e , Rohtak and Delhi, which had an impact on how well they understood and utilised the cervical cancer vaccination. It is worth mentioning that none of the women from Rohtak had received the immunisation. The awareness of the cervical cancer vaccine among women from the Rohtak was lower than the Delhi women.     

Absolute risks of cervical precancer among women who fulfill exiting guidelines based on HPV and cytology cotesting

US guidelines recommend that most women older than 65 years cease cervical screening after two consecutive negative cotests (concurrent HPV and cytology tests) in the previous 10 years, with one in the last 5 years. However, this recommendation was based on expert opinion and modeling rather than empirical data on cancer risk. We therefore estimated the 5-year risks of cervical precancer (cervical intraepithelial neoplasia grade 3 or adenocarcinoma in situ [CIN3]) after one, two and three negative cotests among 346,760 women aged 55–64 years undergoing routine cotesting at Kaiser Permanente Northern California (2003–2015). Women with a history of excisional treatment or CIN2+ were excluded. No woman with one or more negative cotests was diagnosed with cancer during follow-up. Five-year risks of CIN3 after one, two, and three consecutive negative cotests were 0.034% (95% CI: 0.023%–0.046%), 0.041% (95% CI: 0.007%–0.076%) and 0.016% (95% CI: 0.000%–0.052%), respectively (p_trend < 0.001). These risks did not appreciably differ by a positive cotest result prior to the one, two or three negative cotest(s). Since CIN3 risks after one or more negative cotests were significantly below a proposed 0.12% CIN3+ risk threshold for a 5-year screening interval, a longer screening interval in these women is justified. However, the choice of how many negative cotests provide sufficient safety against invasive cancer over a woman's remaining life represents a value judgment based on the harms versus benefits of continued screening. Ideally, this guideline should be informed by longer-term follow-up given that exiting is a long-term decision.     

Tuberculosis and oncogenic HPV: potential co-infections in women at high-risk of cervical cancer in rural China

The study was embedded in Shanxi Province Cervical Cancer Screening Study II with the aim of examining the association between history of diagnosed tuberculosis or cervical inflammation and oncogenic human papillomavirus (HPV) infection, persistent oncogenic HPV infection, cervical intraepithelial neoplasia grade 3 or cervical cancer (CIN3+) in an isolated rural population of China. A total of 8,798 women were recruited for cervical cancer screening and an interviewer-administered questionnaire. Of the women in the study, 2.7% and 34% reported a diagnosis of tuberculosis and cervical inflammation, respectively. In the model for HPV infection, HPV persistence and CIN3+, we show an increasing magnitude of effect of tuberculosis with increasing severity of disease, as demonstrated by the increasing odds ratios from 1.68 for HPV positivity, to 1.75 for persistent HPV and then 2.08 for CIN3+. Women reporting a diagnosis of tuberculosis, cervical inflammation or both tuberculosis and cervical inflammation were at 75%, 22% and 113% higher odds of persistent HPV infection, respectively. One percent of the study population was diagnosed with tuberculosis and cervical inflammation, placing them at 90% and 113% higher odds of infection with HPV and persistent HPV, respectively. Tuberculosis and oncogenic HPV are identified for the first time as co-infections in rural unscreened women in Shanxi Province, China, highlighting the importance of infection history in assessing an individual' s risk for HPV infection, persistence and CIN3+.     

HPV蛋白、miRNAs和外泌体在宫颈癌炎症作用中的研究进展

人乳头瘤状病毒(Human papilloma virus,HPV)感染是导致宫颈癌发生发展最重要的危险因素。目前有研究表明,HPV蛋白直接或间接参与慢性炎症发生,进而促进肿瘤发展。非编码RNA(miRNAs)是基因表达的调控因子,也是炎症通路的关键参与者,miRNAs的异常表达可能与宫颈癌的炎性反应有关。外泌体是细胞分泌到细胞外的囊泡,这些囊泡可以作为运载体与受体结合。最近研究发现外泌体参与了炎症过程,影响免疫反应。在这篇综述中,我们讨论了HPV蛋白、miRNAs和外泌体在宫颈癌炎症作用中的研究进展。     

Antibodies to Human Papillomavirus 16, 18, 58, and 6b Major Capsid Proteins among Japanese Females

Among genital human papillomaviruses (HPVs), the so-called high-risk (HPV 16, 18, etc.) and intermediate-risk (HPV 58, etc.) viruses are believed to be etiologically associated with cervical cancer. To estimate the extent of infection with common HPVs among Japanese females, we examined 328 sera from healthy donors (201) and patients with cervical intraepithelial neoplasia (GIN) (22), cervical cancer (67), and condyloma acuminatum (CA) (38) for IgG antibodies against L1 capsid protein by enzyme-linked immunosorbent assay using virus-like particles of HPVs 16, 18, 58 and 6b (low-risk) as antigens. Antibodies recognizing conformational epitopes were found in the sera from both the patients and the healthy donors. The prevalences of anti-HPV 16,18, and 58 antibodies in the sera from the patients with CIN (45%) and cervical cancer (49%), and that of anti-HPV 6b in the sera from the patients with CA (55%), were significantly higher than those in the sera from the age-matched healthy donors (12%, 14%, and 23%, respectively). Anti-HPV 16 was not found in some of the sera from patients with HPV 16-DNA positive CIN or cervical cancer, suggesting that HPV infection may not always induce production of anti-capsid antibodies or that the level of antibodies may not always be maintained until development of CIN or cancer. Some of the sera contained antibodies against more than one type of HPV, suggesting that the donors had been infected with different HPVs. The type-specific antibodies against capsid L1 protein of one type of HPV may not be able to prevent infections with other types of HPVs.     

HPV prevalence and cervical intraepithelial neoplasia among HIV-infected women in Yunnan Province, China: a pilot study

Objectives: To determine the prevalence of HPV and cervical neoplasia among HIV-infected women insouthwestern China. Methods: Cervical cytology, HPV detection by Hybrid Capture-2™ assay, and diagnosticcolposcopy were followed by cervical biopsy if indicated. Logistic regression analysis was used to analyzeassociations between HPV co-infection and cervical intraepithelial neoplasia (CIN), and HIV-related clinicaland laboratory parameters. Results: Colposcopic-histopathologically proven CIN2+ lesions were present in7/83 (8.4%) HIV-infected women. Nearly half (41/83, 43%) were co-infected with carcinogenic HPV genotypes.HPV co-infection was higher in women with colposcopic-histopathologically proven CIN2+ lesions than womenwith 相似文献   

Association of HPV35 with cervical carcinogenesis among women of African ancestry: Evidence of viral-host interaction with implications for disease intervention

HPV35 has been found in only ∼2% of invasive cervical cancers (ICC) worldwide but up to 10% in Sub-Saharan Africa, warranting further investigation and consideration of impact on preventive strategies. We studied HPV35 and ethnicity, in relation to the known steps in cervical carcinogenesis, using multiple large epidemiologic studies in the U.S. and internationally. Combining five U.S. studies, we measured HPV35 positivity and, in Northern California, observed HPV35 type-specific population prevalence and estimated 5-year risk of developing precancer when HPV35-positive. HPV35 genetic variation was examined for differences in carcinogenicity in 1053 HPV35+ cervical specimens from a U.S. cohort and an international collection. African-American women had more HPV35 (12.1% vs 5.1%, P < .001) and more HPV35-associated precancers (7.4% vs 2.1%, P < .001) compared to other ethnicities. Precancer risks after HPV35 infection did not vary by ethnicity (global P = .52). The HPV35 A2 sublineage showed an increased association with precancer/cancer in African-Americans (OR = 5.6 vs A1, 95% CI = 1.3-24.8) and A2 was more prevalent among ICC in Africa than other world regions (41.9% vs 10.4%, P < .01). Our analyses support a strong link between HPV35 and cervical carcinogenesis in women of African ancestry. Current HPV vaccines cover the majority of cervical precancer/cancer across all ethnic groups; additional analyses are required to determine whether the addition of HPV35 to the already highly effective nine-valent HPV vaccine would provide better protection for women in Africa or of African ancestry.