Human papillomavirus vaccination and respect for children’s developing autonomy: Results from a European Union wide study

Children’s rights to autonomy of choice are differently expressed throughout Europe. We explored differences regarding expressions of respect for children’s autonomy throughout Europe, using the procedure of human papillomavirus (HPV) vaccination offer as indicator. We used a mixed methods approach, utilizing an expert survey within the frame of “Models of Child Health Appraised” (MOCHA), among all 30 European Union (EU) and European Economic Area states. A questionnaire was designed using vignettes regarding the vaccine provision. Thirty MOCHA country agents were invited to respond from June 2017 to April 2018. In total, 28 country agents responded. We studied the following themes: (i) provision of informed consent, (ii) parental and medical paternalism, (iii) relevance of the child’s chronological age or maturity, and (iv) vaccination programs targeting boys. These are being handled differently across the region. We explored associations of these implemented practices with the national vaccine coverage rate across Europe. We used the processes of HPV vaccination to study child’s autonomy, the paradigm change toward libertarian paternalism and issues of sex-equity. Interestingly, greater respect for children’s autonomy tends to be associated with medium or high vaccination coverage rates and lower respect with lower rates. Respect and empowerment seem to have practical as well as moral benefits. Identifying and transferring the most suitable ethical approaches is crucial and should be strengthened.

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Human papillomavirus vaccination: the population impact

F1000Research ◽

10.12688/f1000research.10691.1 ◽

2017 ◽

Vol 6 ◽

pp. 866 ◽

Cited By ~ 41

Author(s):

Lai-yang Lee ◽

Suzanne M. Garland

Keyword(s):

Human Papillomavirus ◽

Vaccine Coverage ◽

Cervical Screening ◽

Hpv Vaccination ◽

National Guidelines ◽

Human Papillomavirus Vaccination ◽

Vaccination Programs ◽

Screening Programs ◽

National Immunisation ◽

The Impact

We currently have the knowledge and experience to prevent much of human papillomavirus (HPV)-related disease burden globally. In many countries where prophylactic HPV vaccination programs have been adopted as highly effective public health programs with good vaccine coverage, we are already seeing, in real-world settings, reduction of vaccine-related HPV-type infections, genital warts and cervical pre-cancers with potential reductions in vulvar, vaginal and anal pre-cancers. Moreover, we are seeing a change in cervical screening paradigms, as HPV-based screening programs now have strong evidence to support their use as more sensitive ways to detect underlying cervical abnormalities, as compared with conventional cervical cytology. This article describes the impact of prophylactic vaccination on these outcomes and in settings where these vaccines have been implemented in national immunisation programs. Given the successes seen to date and the availability of essential tools, there has been a global push to ensure that every woman has access to effective cervical screening and every girl has the opportunity for primary prevention through vaccination. A gender-neutral approach by offering vaccination to young boys has also been adopted by some countries and is worthy of consideration given that HPV-related cancers also affect males. Furthermore, vaccination of young boys has the advantage of reducing the risk of HPV transmission to sexual partners, lowering the infectious pool of HPV in the general population and ultimately HPV-related diseases for both genders. Therefore, it is appropriate that all countries consider and promote national guidelines and programs to prevent HPV-related diseases.

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Cost-effectiveness of a bivalent human papillomavirus vaccination program in Japan

Sexual Health ◽

10.1071/sh14241 ◽

2015 ◽

Vol 12 (6) ◽

pp. 520 ◽

Cited By ~ 5

Author(s):

Luke B. Connelly ◽

Ha N. D. Le

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cost Effectiveness ◽

Screening Program ◽

Vaccine Coverage ◽

Precancerous Lesions ◽

Hpv Vaccination ◽

Vaccination Program ◽

Human Papillomavirus Vaccination ◽

The Cost

Background Human papillomavirus (HPV) vaccines and their widespread adoption have the potential to relieve a large part of the burden of cervical cancer morbidity and mortality, particularly in countries that have low screening rates or, like Japan, lack a cohesive universal screening program. An economic evaluation was conducted to assess the cost-effectiveness of introducing a bivalent HPV vaccination program in Japan from a healthcare perspective. Methods: A Markov model of the natural history of HPV infection that incorporates both vaccination and screening was developed for Japan. The modelled intervention, a bivalent HPV vaccine with a 100% lifetime vaccine efficacy and 80% vaccine coverage, given to a cohort of 12-year-old Japanese girls in conjunction with the current screening program, was compared with screening alone in terms of costs and effectiveness. A discount rate of 5% was applied to both costs and utilities where relevant. Results: Vaccination alongside screening compared with screening alone is associated with an incremental cost-effectiveness ratio (ICER) of US$20 315 per quality-adjusted-life-year gained if 80% coverage is assumed. The ICER at 5% coverage with the vaccine plus screening, compared with screening alone, is US$1158. Conclusion: The cost-effectiveness results suggest that the addition of a HPV vaccination program to Japan’s cervical cancer screening program is highly likely to prove a cost-effective way to reduce the burden of cervical cancer, precancerous lesions and HPV16/18-related diseases.

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Human papillomavirus vaccination in the European Union/European Economic Area and globally: a moral dilemma

Eurosurveillance ◽

10.2807/1560-7917.es.2021.26.50.2001659 ◽

2021 ◽

Vol 26 (50) ◽

Author(s):

Edoardo Colzani ◽

Kari Johansen ◽

Helen Johnson ◽

Lucia Pastore Celentano

Keyword(s):

Cervical Cancer ◽

European Union ◽

Human Papillomavirus ◽

Moral Dilemma ◽

Hpv Vaccination ◽

World Health ◽

European Economic Area ◽

European Economic ◽

Economic Area ◽

Dose Sparing

While many European Union/European Economic Area (EU/EEA) countries recently expanded human papillomavirus (HPV) vaccination to boys, HPV vaccine supply is currently limited for girls in low- and middle-income countries (LMIC) that are severely affected by HPV. Globally, about 50% of countries have introduced HPV vaccination. Some LMIC with high burden of cervical cancer have not yet introduced HPV vaccination, or are reaching suboptimal vaccination coverage. While WHO issued a call for cervical cancer elimination in 2018, a global shortage of HPV vaccines is currently predicted to last at least until 2024. We reviewed national policies of EU/EEA countries and recommendations of the World Health Organization (WHO) Strategic Advisory Group of Experts on immunisation to discuss current challenges and dose-sparing options. Several EU/EEA countries have extended HPV vaccination to boys and the European Cancer Organisation has issued a resolution for elimination of all HPV-associated cancers in both sexes. The European Centre for Disease Prevention and Control concluded in its 2020 guidance that cost-effectiveness of extending routine vaccination to boys depends on several context-specific factors. The extension of HPV vaccination to boys in EU/EEA countries may affect global availability of vaccines. Temporary dose-sparing options could be considered during the COVID-19 post-pandemic period.

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Online media scans: Applying systematic review techniques to assess statewide human papillomavirus vaccination activities

Journal of Public Health Research ◽

10.4081/jphr.2019.1623 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Emily Ann Groene ◽

Inari Mohammed ◽

Keith Horvath ◽

Nicole E. Basta ◽

Nicholas Yared ◽

...

Keyword(s):

Human Papillomavirus ◽

Health Education ◽

Rural Areas ◽

Hpv Vaccine ◽

Urban Areas ◽

Vaccine Coverage ◽

Hpv Vaccination ◽

Online Media ◽

Human Papillomavirus Vaccination ◽

Research Activities

Background. Although the human papillomavirus (HPV) vaccine has been approved for use in adolescents in the US for over a decade, vaccination uptake remains low. Of concern, HPV vaccine coverage is below the national average in Minnesota, USA. To understand the reach of current HPV programming and research, we use an online media scan; this method may be applied to other jurisdictions to gain insight about various public health issues.Design and Methods. This online media scan describes the nature and scope of ongoing activities to increase HPV vaccination in Minnesota. The media scan included: a) structured internet searches of HPV vaccine health education/promotion activities ongoing in Minnesota since 2013, and b) searches in research databases of the published literature on HPV vaccination in Minnesota from 2013 to 2018. Results. Searches resulted in 880 online and 142 research article matches, with 40 and 36 meeting selection criteria. Results were categorized by activities focusing on race/ethnicity, sex, health providers, parents, lesbian, gay, bisexual, transgender and queer or questioning (LGBTQ) populations, geographic location, catchup vaccination, and insurance status. Most activities were statewide (52% health education/promotion and 35% research), followed by activities located in entirely urban areas (15% health education/promotion and 41% research) with only 6% of health education/promotion activities and 2% of research activities carried out in entirely rural areas.Conclusions. A range of local and statewide HPV vaccine health education/promotion and research activities were identified in Minnesota. Several efforts partnered with American Indian and Somali/Somali-American communities, but fewer activities focused on HPV vaccination among LGBTQ youth and HPV vaccination in rural areas.

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Who Will Benefit From Expanding HPV Vaccination Programs to Boys?

JNCI Cancer Spectrum ◽

10.1093/jncics/pky076 ◽

2018 ◽

Vol 2 (4) ◽

Cited By ~ 1

Author(s):

Venetia Qendri ◽

Johannes A Bogaards ◽

Johannes Berkhof

Keyword(s):

Cancer Prevention ◽

Vaccine Coverage ◽

Hpv Vaccination ◽

Cervical Cancer Prevention ◽

Heterosexual Men ◽

Human Papillomavirus Vaccination ◽

Vaccination Programs ◽

Herd Protection ◽

Life Years ◽

Sex With Men

Abstract Indications for human papillomavirus vaccination programs are expanding to boys. However, the rationale behind their inclusion is often not clear. Using a Bayesian synthesis framework and assuming equal vaccine coverage in both sexes, we assessed how the incremental number of cancer cases prevented and life-years gained from boys’ vaccination are distributed between women, heterosexual men, and men who have sex with men (MSM). Below 60% coverage, at least 50% of the gains from boys’ vaccination was attributable to cervical cancer prevention, whereas at 80% coverage, 50% of the gains was attributable to women, 15% to heterosexual men, and 35% to MSM. Above 90% coverage, 85–100% of the gains from boys’ vaccination was attributable to anal and oropharyngeal cancer prevention, mainly in MSM. Sex-neutral vaccination can be advocated on grounds of bolstering herd protection to women and directly protecting men, particularly MSM, with the clinical significance of either argument determined by the coverage.

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Opportunities to increase rates of human papillomavirus vaccination in the New South Wales school program through enhanced catch-up

Sexual Health ◽

10.1071/sh15132 ◽

2016 ◽

Vol 13 (6) ◽

pp. 536 ◽

Cited By ~ 5

Author(s):

Christine Staples ◽

Michelle Butler ◽

Jennifer Nguyen ◽

David N. Durrheim ◽

Patrick Cashman ◽

...

Keyword(s):

High School Students ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Vaccine Coverage ◽

Hpv Vaccination ◽

Vaccination Program ◽

Completion Rates ◽

School Program ◽

Human Papillomavirus Vaccination ◽

Catch Up

Background The National Human Papillomavirus (HPV) Vaccination Program provides HPV vaccine to high school students through school-based vaccination. We aimed to: 1) assess the vaccine completion rates achieved when general practice is used for completing doses missed at school; 2) estimate the extent of under-notification by general practices of vaccine doses administered; and 3) assess the reasons reported by parents of students for non-completion of HPV vaccination. Methods: A postal survey was conducted of parents and carers of students and identified, using school-program records, as incompletely vaccinated in a large regional area of northern NSW vaccinated during 2010. Information about additional HPV vaccine doses received or reasons for non-completion were sought. Responses were analysed and records cross-checked against the National HPV Vaccination Program Register. Results: Of 660 parents or carers contacted, 207 (31.4%) responded. We found: 1) completion rates increased, an additional 122/207 (45.2%) students had completed all three doses of HPV through their general practitioner (GP); 2) under-notification of GP doses to the National HPV Vaccination Program Register was an issue with only 5/165 (3.0%) reported; 3) the main reason for non-completion was being unaware of the opportunity to catch-up at a GP. Conclusions: Underreporting by GPs of HPV vaccine doses administered and failure to complete courses identifies two opportunities to increase HPV vaccine coverage. These could be addressed by extending provision of catch-up HPV doses in school and by developing practice software solutions for automatic notification of doses from GPs. Reasons given by parents for non-completion, mostly logistical barriers, indicate a high degree of acceptance of HPV vaccination.

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Evolution of Public Health Human Papillomavirus Immunization Programs in Canada

Current Oncology ◽

10.3390/curroncol28010097 ◽

2021 ◽

Vol 28 (1) ◽

pp. 991-1007

Author(s):

Alexandra Goyette ◽

Glorian P. Yen ◽

Voica Racovitan ◽

Parambir Bhangu ◽

Smita Kothari ◽

...

Keyword(s):

Public Health ◽

Human Papillomavirus ◽

Vaccination Coverage ◽

Prince Edward Island ◽

Hpv Vaccination ◽

Hpv Infection ◽

After School ◽

Vaccination Programs ◽

School Based ◽

Coverage Rates

Background: Since 2007, all Canadian provinces and territories have had a publicly funded program for vaccination against human papillomavirus (HPV) infection. The objective of this study was to describe the evolution of these vaccination programs. Methods: This was a targeted literature review of public HPV vaccination programs and vaccination coverage rates, based on information provided by jurisdictional public health authorities. Results: HPV vaccination of schoolgirls began in school years 2007/08 to 2010/11 with three doses of the quadrivalent HPV vaccine in all provinces except Quebec, which started with two doses. By 2018/19, all jurisdictions were vaccinating with two doses of the nonavalent vaccine in both girls and boys, except Quebec, which used a mixed vaccination schedule with one dose of the nonavalent and one dose of the bivalent vaccines. Public HPV vaccination programs in most provinces include after-school catch-up vaccination. Immunocompromised or other high-risk individuals are eligible for the HPV public vaccination program in most provinces, but policies vary by jurisdiction. In 2017/18, vaccination coverage rates in provincial HPV school-based programs varied from 62% in Ontario to 86% in Prince Edward Island in girls and from 58% in Ontario to 86% in Prince Edward Island in boys. Conclusions: Since their introduction, Canadian school-based HPV public vaccination programs have evolved from a three-dose to a two-dose schedule, from a quadrivalent to a nonavalent vaccine, and from a girls-only to a gender-neutral policy. Vaccination coverage rates have varied markedly and only Prince Edward Island and Newfoundland/Labrador have maintained rates exceeding 80%.

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State of art of anti- Human Papillomavirus vaccination programs and vaccine coverage levels: comparison between Italy and others European countries

European Journal of Public Health ◽

10.1093/eurpub/cku161.030 ◽

2014 ◽

Vol 24 (suppl_2) ◽

Cited By ~ 2

Author(s):

AM Ferriero ◽

ML Specchia ◽

C Cadeddu ◽

E Lovato ◽

W Ricciardi

Keyword(s):

Human Papillomavirus ◽

Vaccine Coverage ◽

European Countries ◽

Human Papillomavirus Vaccination ◽

Vaccination Programs ◽

State Of Art

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A Long-Term Observation on the Possible Adverse Effects in Japanese Adolescent Girls after Human Papillomavirus Vaccination

Vaccines ◽

10.3390/vaccines9080856 ◽

2021 ◽

Vol 9 (8) ◽

pp. 856

Author(s):

Akiyo Hineno ◽

Shu-Ihi Ikeda

Keyword(s):

Human Papillomavirus ◽

Adverse Effects ◽

Orthostatic Intolerance ◽

Hpv Vaccination ◽

Pain Syndrome ◽

Causal Link ◽

Human Papillomavirus Vaccination ◽

Chronic Regional Pain Syndrome ◽

Laboratory Test Results ◽

Long Term Observation

In Japan, a significant number of adolescent females noted unusual symptoms after receiving the human papillomavirus (HPV) vaccination, of which the vast majority of them were initially diagnosed with psychiatric illnesses because of the absence of pathologic radiological images and specific abnormalities in laboratory test results. Later these symptoms were thought to be adverse effects of HPV vaccination. However, a causal link between HPV vaccination and the development of these symptoms has not been demonstrated. Between June 2013 and March 2021, we examined 200 patients who noted various symptoms after HPV vaccination. In total, 87 were diagnosed with HPV vaccination-related symptoms based on our proposed diagnostic criteria. The clinical histories of these 87 patients were analyzed. The age at initial vaccination ranged from 11 to 19 years old (mean ± SD: 13.5 ± 1.5 years old), and the age at the first appearance of symptoms ranged from 12 to 20 years old (mean ± SD: 14.3 ± 1.6 years old). The patients received an initial HPV vaccine injection between May 2010 and May 2013, but the first affected patient developed symptoms in October 2010, and the last affected developed symptoms in October 2015. A cluster of patients with a post-HPV vaccination disorder has not appeared in Japan during the last five years. Our study shows that, in Japan, the period of HPV vaccination considerably overlapped with that of a unique post-HPV vaccination disorder development. This disorder appears as a combination of orthostatic intolerance, chronic regional pain syndrome, and cognitive dysfunction, but its exact pathogenesis remains unclear.

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