Effectiveness of 1, 2, and 3 Doses of Human Papillomavirus Vaccine Against High-Grade Cervical Lesions Positive for Human Papillomavirus 16 or 18

Abstract Before 2016, human papillomavirus (HPV) vaccination was recommended on a 3-dose schedule. However, many vaccine-eligible US females received fewer than 3 doses, which provided an opportunity to evaluate the real-world vaccine effectiveness (VE) of 1, 2, and 3 doses. We analyzed data on cervical intraepithelial neoplasia (CIN) grades 2–3 and adenocarcinoma in situ (designated CIN2+) from the HPV Vaccine Impact Monitoring Project (HPV-IMPACT; 2008–2014). Archived tissue from CIN2+ lesions was tested for 37 types of HPV. Women were classified by number of doses received ≥24 months before CIN2+ detection. Using a test-negative design, VE was estimated as 1 minus the adjusted odds ratio from a logistic regression model that compared vaccination history for women whose lesions tested positive for HPV-16/18 (vaccine-type cases) with that for women who had all other CIN2+ lesions (controls). Among 3,300 women with available data on CIN2+, typing results, and vaccine history, 1,561 (47%) were HPV-16/18–positive, 136 (4%) received 1 dose of HPV vaccine, 108 (3%) received 2 doses, and 325 (10%) received 3 doses. Adjusted odds ratios for vaccination with 1, 2, and 3 doses were 0.53 (95% confidence interval (CI): 0.37, 0.76; VE = 47%), 0.45 (95% CI: 0.30, 0.69; VE = 55%), and 0.26 (95% CI: 0.20, 0.35; VE = 74%), respectively. We found significant VE against vaccine-type CIN2+ after 3 doses of HPV vaccine and lower but significant VE with 1 or 2 doses.

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The Impact of the Human Papillomavirus Vaccine on High-Grade Cervical Lesions in Urban and Rural Areas: An Age–Period–Cohort Analysis

Cancers ◽

10.3390/cancers13164215 ◽

2021 ◽

Vol 13 (16) ◽

pp. 4215

Author(s):

Jaimie Z. Shing ◽

Alicia Beeghly-Fadiel ◽

Marie R. Griffin ◽

Rachel S. Chang ◽

Staci L. Sudenga ◽

...

Keyword(s):

Human Papillomavirus ◽

Rural Areas ◽

Cohort Analysis ◽

Hpv Vaccination ◽

Cohort Effects ◽

Adenocarcinoma In Situ ◽

Human Papillomavirus Vaccine ◽

Cervical Lesions ◽

Annual Percent Change ◽

The Impact

Disparities in human papillomavirus (HPV) vaccination exist between urban (metropolitan statistical areas (MSAs)) and rural (non-MSAs) regions. To address whether the HPV vaccine’s impact differs by urbanicity, we examined trends in cervical intraepithelial neoplasia grades 2 or 3 and adenocarcinoma in situ (collectively, CIN2+) incidence in MSAs and non-MSAs among Tennessee Medicaid (TennCare)-enrolled women aged 18–39 years and among the subset screened for cervical cancer in Tennessee, United States. Using TennCare claims data, we identified annual age-group-specific (18–20, 21–24, 25–29, 30–34, and 35–39 years) CIN2+ incidence (2008–2018). Joinpoint regression was used to identify trends over time. Age–period–cohort Poisson regression models were used to evaluate age, period, and cohort effects. All analyses were stratified by urbanicity (MSA versus non-MSA). From 2008–2018, 11,243 incident CIN2+ events (7956 in MSAs; 3287 in non-MSAs) were identified among TennCare-enrolled women aged 18–39 years. CIN2+ incident trends (2008–2018) were similar between women in MSAs and non-MSAs, with largest declines among ages 18–20 (MSA average annual percent change (AAPC): −30.4, 95% confidence interval (95%CI): −35.4, −25.0; non-MSA AAPC: −30.9, 95%CI: −36.8, −24.5) and 21–24 years (MSA AAPC: −14.8, 95%CI: −18.1, −11.3; non-MSA AAPC: −15.1, 95%CI: −17.9, −12.2). Significant declines for ages 18–20 years began in 2008 in MSAs compared to 2010 in non-MSAs. Trends were largely driven by age and cohort effects. These patterns were consistent among screened women. Despite evidence of HPV vaccine impact on reducing CIN2+ incidence regardless of urbanicity, significant declines in CIN2+ incidence were delayed in non-MSAs versus MSAs.

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Safety and Immunogenicity of the Quadrivalent Human Papillomavirus Vaccine in Patients with Juvenile Dermatomyositis: A Real-World Multicentre Study

10.21203/rs.2.22478/v1 ◽

2020 ◽

Author(s):

Natalia Balera Ferreira Pinto ◽

Ingrid Herta Rotstein Grein ◽

Aline Lobo ◽

Noortje Groot ◽

Flavio Sztajnbok ◽

...

Keyword(s):

Human Papillomavirus ◽

Adverse Events ◽

Disease Activity ◽

Hpv Vaccine ◽

Juvenile Dermatomyositis ◽

Hpv Vaccination ◽

Dose Schedule ◽

Control Group ◽

Human Papillomavirus Vaccine ◽

One Year

Abstract Background: Concerns about the safety and efficacy of vaccinations in patients with pediatric rheumatic diseases, such as juvenile dermatomyositis, have led to contradictions and low vaccination coverage in this group, who are at a higher risk of infections, including by human papillomavirus (HPV). Although HPV vaccine should be recommended for all juvenile dermatomyositis patients, there is a lack of data to support the safety of this vaccine. The aim of this study was to assess the safety and immunogenicity of the quadrivalent HPV vaccination in juvenile dermatomyositis patients.Methods: Juvenile dermatomyositis patients aged from 9-20 years and healthy controls were enrolled to receive a 3-dose schedule of quadrivalent HPV vaccination from March/2014 until March/2016. Study visits were performed before the first dose, one month after the second and third doses and one year after the first dose. Participants completed a diary of possible adverse events following each dose, and disease activity was measured. At each visit, serum samples was collected for testing antibody concentrations. Participants recruitment was conducted in ten Brazilian centers. From 48 eligible patients, 42 completed the 3 doses schedule of the vaccine (5 patients had received doses previously). The McNemar test and the Kappa concordance coefficient were applied to compare the disease activity scores used for juvenile dermatomyositis patients between quadrivalent HPV vaccine doses and before the vaccination. The software used was SAS 9.4.Results: No severe adverse events were related to the vaccination. The disease activity scores were usually low, and remained stable, or even improved during the follow-up. After three vaccine doses the juvenile dermatomyositis group presented seropositivity of 100% for HPV16 and 97% for HPV18, similarly to the control group who presented 100% for both. One year after the first dose the seropositivity for the patients group was 94% for both HPV types.Conclusions: The HPV vaccination in juvenile dermatomyositis patients is safe and immunogenic. Since the seropositivity against HPV16 and HPV18 was very high after the 3-dose schedule, this regimen should be recommended for juvenile dermatomyositis patients.

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Predictors of Human Papillomavirus Vaccine uptake or intent among parents of preadolescents and adolescents

Journal of Nursing Education and Practice ◽

10.5430/jnep.v7n6p35 ◽

2017 ◽

Vol 7 (6) ◽

pp. 35 ◽

Cited By ~ 2

Author(s):

Kimberlee Dayal ◽

Sarah Robinson ◽

Jessica Schoening ◽

Mary Catherine Smith ◽

Son Chae Kim

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Parental Education ◽

Hpv Vaccination ◽

College Education ◽

Vaccine Effectiveness ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Hpv Knowledge ◽

Hpv Vaccine Uptake

Aim: The aim of this study was to examine predictors of human papillomavirus (HPV) vaccine uptake or intent among parents of pre-adolescents and adolescents.Methods: A cross-sectional descriptive study was conducted among parents of girls aged 9 to 18 years, visiting two primary care clinics in central Texas from September to November 2015. Pearson’s product-moment correlation procedures and path analyses based on Health Belief Model were performed.Results: Path analysis showed that provider recommendation for HPV vaccination (β = 0.37; p < .001) and perceived HPV vaccine harm (β = -0.48; p < .001) had statistically significant direct effects on HPV vaccine uptake or intent. The perceived HPV vaccine effectiveness was directly influenced by HPV knowledge (β = 0.39; p < .001), empowerment in parent-provider relationships (β = 0.30; p = .006) and parental college education (β = 0.23; p = .039).}Conclusions: Together with parental empowerment fostering an equal partnership with providers, targeted education to improve parental HPV knowledge may convince them of the HPV vaccine effectiveness. This, in turn, may help them put the perceived HPV vaccine harm in proper perspective and allow them to make informed decisions regarding the timely HPV vaccination of their children. Because provider recommendation is one of the most important contributing factors for HPV vaccine uptake or intent, parental education and recommendations from nurses will help reduce the knowledge gaps and empower parents to make the timely decisions to vaccinate their children.

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Challenges to Human Papillomavirus Vaccine Acceptability among Women in South India: An Exploratory Study

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1650 ◽

2021 ◽

Author(s):

Pooja Shah ◽

Veena Shetty ◽

Maithri Ganesh ◽

Avinash K. Shetty

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Exploratory Study ◽

Social Stigma ◽

Hpv Vaccination ◽

Scale Up ◽

Vaccine Safety ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Barriers And Challenges

Cervical cancer is the second leading cause of cancer and one of the leading causes of cancer-related death in women in India. Human papillomavirus (HPV) vaccine uptake in India is low due to cost, low awareness of HPV, social stigma, and other factors. We assessed the awareness, attitudes, and beliefs regarding HPV and HPV vaccination and explored the barriers and challenges to HPV vaccine intent among women in Mangalore, India. An exploratory study was conducted using two focus group discussions (FGDs) and six in-depth one-on-one interviews. FGD-1 comprised nine women aged 18 to 26 years, and FGD-2 comprised seven women aged 27 to 45 years. The FGDs were recorded, transcribed, and analyzed using thematic content analysis. Themes identified were limited knowledge of HPV and vaccine, stigma associated with receiving HPV vaccine, vaccine safety concerns, and cost as a barrier to receiving vaccine. Participants expressed desire for physician and government recommendation of the HPV vaccine to validate vaccine intent. Contrasting themes between the two FGDs include support for vaccination at a younger age and lower perception of stigma and judgment in the 18- to 26-year-old group; however, participants in the 27- to 45-year-old group support vaccination at an older age and endorse greater fear of stigma and judgment associated with obtaining vaccination. Education regarding HPV-associated diseases and the HPV vaccine for the general public, physicians, and government officials in conjunction with lowering vaccine cost, improving vaccine access, and encouraging strong physician recommendations are key strategies to scale up HPV vaccine implementation in India.

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Safety and immunogenicity of the quadrivalent human papillomavirus vaccine in patients with juvenile dermatomyositis: a real-world multicentre study

Pediatric Rheumatology ◽

10.1186/s12969-020-00479-w ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Ingrid Herta Rotstein Grein ◽

Natalia Balera Ferreira Pinto ◽

Noortje Groot ◽

Camila Bertini Martins ◽

Aline Lobo ◽

...

Keyword(s):

Human Papillomavirus ◽

Disease Activity ◽

Juvenile Dermatomyositis ◽

Hpv Vaccination ◽

Dose Schedule ◽

Current Therapy ◽

Human Papillomavirus Vaccine ◽

Serum Samples ◽

The Third ◽

Clinical Trials Registry

Abstract Background Concerns about the safety and efficacy of vaccines in patients with autoimmune diseases (AID) have led to contradictions and low vaccination coverage in this population, who are at a higher risk of infections, including by human papillomavirus (HPV). Although HPV vaccines have been recommended for immunocompromised patients, there is still a lack of data to support its use for AID patients, such as juvenile dermatomyositis (JDM) patients. The aim of this study was to assess the safety and immunogenicity of the quadrivalent HPV (qHPV) vaccine in a cohort of JDM patients. Methods JDM patients aged from 9 to 20 years and healthy controls (HC) were enrolled to receive a 3-dose schedule of qHPV vaccine from March/2014 to March/2016. Study visits were performed before the first dose, 1 month after the second and third doses, and 6 months after the third dose. Participants completed a diary of possible adverse events for 14 days following each dose of vaccination (AEFV). Disease activity and current therapy were analyzed at each visit for JDM patients. In addition, serum samples from all participants were collected to test antibody concentrations against HPV16 and 18 at each visit. Participant recruitment was conducted in ten Brazilian centres. From 47 eligible JDM patients and 41 HC, 42 and 35, respectively, completed the 3-dose schedule of the vaccine, given that five JDM patients and two HC had received doses prior to their inclusion in the study. Results The AEFVs presented by the participants were mild and in general did not differ between JDM and HC groups. No severe AEFVs were related to the vaccination. Disease activity was stable, or even improved during the follow-up. One month after the third dose of the vaccine the JDM group presented seropositivity of 100% for HPV16 and 97% for HPV18, similarly to the HC group, who presented 100% for both serotypes (p = 1.000). Six months after the third dose the seropositivity for the patient group was 94% for both HPV types. Conclusions The HPV vaccination in this cohort of JDM patients was safe and immunogenic. Since the seropositivity against HPV16 and 18 was very high after the 3-dose schedule, this regimen should be recommended for JDM patients. Trial registration Brazilian Clinical Trials Registry, number: RBR-9ypbtf. Registered 20 March 2018 – Retrospectively registered.

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Immunogenicity of a Two-Dose Human Papillomavirus Vaccine Schedule in HIV-Infected Adolescents with Immune Reconstitution

Vaccines ◽

10.3390/vaccines10010118 ◽

2022 ◽

Vol 10 (1) ◽

pp. 118

Author(s):

Supattra Rungmaitree ◽

Charin Thepthai ◽

Zheng Quan Toh ◽

Noppasit Musiwiraphat ◽

Alan Maleesatharn ◽

...

Keyword(s):

Human Papillomavirus ◽

Immune Reconstitution ◽

Geometric Mean ◽

Hpv Vaccination ◽

Human Papillomavirus Vaccine ◽

Hpv 16 ◽

Cell Counts ◽

Increased Risk ◽

2D And 3D ◽

Hpv 18

HIV-infected patients are at increased risk of human papillomavirus (HPV) acquisition and HPV-associated diseases. This study set out to determine whether a two-dose (2D) HPV vaccination schedule was sufficient in HIV-infected adolescents with immune reconstitution (IR) following antiretroviral treatment. Participants aged 9–15 years who had CD4 cell counts > 500 cells/mm3 and HIV-1 RNA < 40 copies/mL for at least one year were assigned to the 2D schedule, while older participants or those without IR received a three-dose (3D) schedule. Antibodies to HPV-16 and -18 were measured using a pseudovirion-based neutralization assay. A total of 96 subjects were enrolled; 31.3% and 68.7% received the 2D and 3D schedule, respectively. Of these, 66.7% and 57.6% of the 2D and 3D participants, respectively, were male. The seroconversion rates for HPV-16 and HPV-18 were 100% in all cases, except for HPV-18 in males who received the 3D schedule (97.4%). In males, the anti-HPV-16 geometric mean titers (GMTs) were 6859.3 (95% confidence interval, 4394.3–10,707.1) and 7011.1 (4648.8–10,573.9) in the 2D and 3D groups (p = 0.946), respectively, and the anti-HPV-18 GMTs were 2039.3 (1432.2–2903.8) and 2859.8 (1810.0–4518.4) in the 2D and 3D (p = 0.313) groups, respectively. In females, the anti-HPV-16 GMTs were 15,758.7 (8868.0–28,003.4) and 26,241.6 (16,972.7–40,572.3) in the 2D and 3D groups (p = 0.197), respectively, and the anti-HPV-18 GMTs were 5971.4 (3026.8–11,780.6) and 9993.1 (5950.8–16,781.1) in the 2D and 3D groups (p = 0.271), respectively. In summary, a 2D schedule is as immunogenic in young adolescents with IR as a 3D schedule in older subjects and those without IR.

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Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study

JMIR Nursing ◽

10.2196/19503 ◽

2020 ◽

Vol 3 (1) ◽

pp. e19503

Author(s):

Anne M Teitelman ◽

Emily F Gregory ◽

Joshua Jayasinghe ◽

Zara Wermers ◽

Ja H Koo ◽

...

Keyword(s):

Human Papillomavirus ◽

Technology Acceptance ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Behavioral Model ◽

The United States ◽

Mobile App ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccine ◽

Vaccination Rates

Background More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI –2.15 to 0.15). Conclusions mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines.

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962. Trends in Cervical Pre-cancers by Race and Ethnicity During the Human Papillomavirus Vaccine Era, HPV Vaccine Impact Monitoring Project (HPV-IMPACT), United States, 2008–2016

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.064 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S29-S29

Author(s):

Julia Gargano ◽

Rayleen Lewis ◽

Hillary Hunt ◽

Nancy McClung ◽

Nancy M Bennett ◽

...

Keyword(s):

United States ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

The United States ◽

Adenocarcinoma In Situ ◽

Human Papillomavirus Vaccine ◽

Impact Monitoring ◽

Vaccine Impact ◽

Race Ethnicity ◽

Papillomavirus Vaccine

Abstract Background Since human papillomavirus (HPV) vaccine introduction in the United States in 2006, cervical pre-cancer incidence has declined in young women, but pre-cancer trends have not been reported by race/ethnicity. We evaluated trends in cervical pre-cancers from 2008 to 2016 in non-Hispanic (NH) white, NH black, NH Asian, and Hispanic women identified through active population-based surveillance in the 5-site Human Papillomavirus Vaccine Impact Monitoring Project (HPV-IMPACT). Methods We analyzed data on cervical intraepithelial neoplasia (CIN) grades 2–3 and adenocarcinoma in situ (CIN2+) cases aged 20–39 years. Annual CIN2+ rates per 100,000 women were calculated stratified by race/ethnicity in 5-year age groups, using multiple imputation to account for 10% missing race/ethnicity data. Rates were also calculated using estimated numbers screened for cervical cancer to control for known declines in screening. Trends, evaluated using JoinPoint software, are presented as average annual percentage changes (AAPC) with 95% confidence intervals (CI). Results A total of 18,222 CIN2+ cases (62% NH white, 16% NH black, 16% Hispanic, 6% Asian) were reported from 2008 to 2016. CIN2+ rates among 20–24 year-olds declined significantly in all groups: NH white, AAPC: −14.2 (95% CI: −16.3, −12.1); NH black, AAPC: −15.5 (−19.5, −11.4); Asian, AAPC: −14.8 (−20.5, −8.8); Hispanic, AAPC: −14.3 (−17.9, −10.5). In 25–29 year olds, a significant decline was observed for NH whites only (AAPC: −2.4, [−4.0, −0.8]). No declines were seen in 30–34 or 35–39 year olds. Among screened 20–24 year-olds, significant but smaller declines were observed (AAPC: −9.8 to −8.4); no declines were observed in screened 25–29 year olds or older groups. Conclusion In this evaluation of CIN2+ trends by race/ethnicity during the HPV vaccine era, the significant declines in 20–24 year olds across all groups, including among screened women, is consistent with equitable vaccine impact on CIN2+. Disclosures All Authors: No reported Disclosures.

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Attitudes about human papillomavirus vaccine in young women

International Journal of STD & AIDS ◽

10.1258/095646203321605486 ◽

2003 ◽

Vol 14 (5) ◽

pp. 300-306 ◽

Cited By ~ 180

Author(s):

Jessica A Kahn ◽

Susan L Rosenthal ◽

Tara Hamann ◽

David I Bernstein

Keyword(s):

Human Papillomavirus ◽

Young Women ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Human Papillomavirus Vaccine ◽

Chi Square ◽

Positive Attitudes ◽

Number Of Sexual Partners ◽

Papillomavirus Vaccine ◽

To Receive

Human papillomavirus (HPV) vaccines are under investigation, but little is known about attitudes regarding vaccination. The aims of this study were to identify attitudes about and intention to receive an HPV vaccine in young women using a theory-based model. Young women ( n=52, mean age 25 years, range 18-30 years, 35% Black/Non-Hispanic) completed a survey assessing knowledge, attitudes about HPV vaccination, and risk behaviours. Associations between attitudes and intention to receive the vaccine were assessed using Mann-Whitney U or chi-square tests. Subjects reported positive attitudes about receiving an HPV vaccine and high intention to receive the vaccine both for themselves and their daughters. Variables associated significantly with intention included knowledge ( P=0.004), personal beliefs about vaccination ( P=0.004), belief that others would approve of vaccination ( P=0.005), and higher number of sexual partners ( P=0.028). Information on attitudes about HPV vaccination and predictors of intention to receive a vaccine may guide immunization initiatives for young adults.

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Acceptability of the Human Papillomavirus Vaccine Among Urban Adolescent Males

American Journal of Men s Health ◽

10.1177/1557988312456697 ◽

2012 ◽

Vol 7 (1) ◽

pp. 27-36 ◽

Cited By ~ 25

Author(s):

Baudelio Gutierrez ◽

Anthony Leung ◽

Kevin Trimell Jones ◽

Peter Smith ◽

Randee Silverman ◽

...

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccine ◽

Hpv Vaccination ◽

Hpv Infection ◽

Adolescent And Young Adult ◽

Human Papillomavirus Vaccine ◽

Adult Males ◽

Urban Adolescent ◽

Increased Risk ◽

Sex With Men

The human papillomavirus (HPV) vaccine was recently approved for use in males. Certain groups, such as men who have sex with men (MSM), are at increased risk of HPV infection. The purpose of the study was to understand perceptions of HPV and the vaccine among adolescent and young adult males, both heterosexual and MSM. Seventy-six males (45 heterosexual, 31 MSM) completed a questionnaire and participated in a focus group. Overall, 42% had heard of HPV and 39% had heard of the HPV vaccine. Males had moderate to favorable attitudes toward vaccination, although intentions to vaccinate were more neutral. MSM were more knowledgeable, aware, and in control of the decision to vaccinate than heterosexual males. Increasing awareness and knowledge about HPV and the vaccine may be necessary to encourage vaccination; certain subgroups of males may be more receptive to HPV vaccination than others.

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