Is human papillomavirus vaccination likely to be a useful strategy in India?

AbstractTwo vaccines that protect against infection by some of the oncogenic human papillomavirus (HPV) subtypes have recently been licensed for use in population-based vaccination strategies in many countries. However, these products are being promoted as ‘cervical cancer vaccines’ based on inadequate data. Specifically, there remain several concerns about the duration of immunogenicity, length of follow-up of trial subjects, endpoints chosen in vaccine trials, applicability of trial results to real populations, the safety of these products, and their cost-effectiveness as public health interventions. Furthermore, it is unlikely that vaccination will obviate the need for setting up robust and cost-effective screening programs in countries like India. This article will discuss various aspects of HPV vaccination from a public health perspective, especially from the point of view of its relevance to India and other South Asian countries.

Download Full-text

Awareness and knowledge of human papillomavirus vaccination and their influential factors among Chinese women: a systematic review

Frontiers of Nursing ◽

10.2478/fon-2019-0048 ◽

2019 ◽

Vol 6 (4) ◽

pp. 317-326

Author(s):

Gui-Dan Tang ◽

Gu-Qing Zeng ◽

Bi-Xia Zhao ◽

Yun-Li Li ◽

Rong Wang ◽

...

Keyword(s):

Public Health ◽

Human Papillomavirus ◽

Hpv Vaccine ◽

Chinese Women ◽

Hpv Vaccination ◽

Influential Factors ◽

Perceived Behavioral Control ◽

Human Papillomavirus Vaccination ◽

Female Population ◽

Multi Level

Abstract Objectives To systematically review the knowledge attitudes and the influential factors on human papillomavirus (HPV) vaccination among Chinese women. Methods Published studies on knowledge and attitudes of HPV vaccination for preventing cervical cancer among Chinese female population were retrieved using the major Chinese and English databases. Meanwhile, handwork retrieval was also conducted and the references including in the literature were retrieved. The quality of the literature was rigorously evaluated and extracted independently by two researchers and the data were analyzed and described by review manager 5.3 (RevMan5.3) software. Results In all, 19 articles including 8 articles in Chinese and 11 in English were chosen. A total of 30,176 participants were included and the sample size ranged from 64 to 6,024. The overall awareness of HPV and HPV vaccine among Chinese women was at a low level. Chinese women generally showed poor knowledge about HPV and HPV vaccine. Acceptance of HPV vaccination among Chinese women was at a high level. Vaccination intentions were influenced by the theory of planned behavior (TPB) and measured by attitudes subjective norms and perceived behavioral control. Conclusions The health authorities may evaluate and develop TPB-based interventions to increase HPV vaccination intentions of Chinese women. HPV vaccination programs should focus on carrying out multi-level and targeted health education and developing effective public health strategies after balancing the cost and benefit of HPV vaccine program. Medical staff should play the positive role in promoting the use of HPV vaccines in China. Integration of policy and community perspectives and multi-level interventions are essential to maximize the public health benefits of HPV vaccination.

Download Full-text

Assessing the value of human papillomavirus vaccination in Gavi-eligible low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003006 ◽

2020 ◽

Vol 5 (10) ◽

pp. e003006

Author(s):

Jessica Ochalek ◽

Kaja Abbas ◽

Karl Claxton ◽

Mark Jit ◽

James Lomas

Keyword(s):

Human Papillomavirus ◽

Low Income ◽

Hpv Vaccination ◽

Cost Effective ◽

Health Impact ◽

Healthcare Intervention ◽

Human Papillomavirus Vaccination ◽

Middle Income ◽

Maximum Price ◽

Healthcare Interventions

IntroductionEstimating the value of providing effective healthcare interventions in a country requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the resources required had, instead, been made available for other healthcare activities in that country. This potential alternative use of the same resources represents the health opportunity cost of providing the intervention. Without such assessments, there is a danger that blanket recommendations made by international organisations will lead to the adoption of healthcare interventions that are not cost effective in some countries, even given existing donor mechanisms intended to support their affordability.MethodsWe assessed the net health impact to 46 Gavi-eligible countries of achieving one of the WHO’s proposed 90-70-90 targets for cervical cancer elimination, which includes 90% coverage of human papillomavirus (HPV) vaccination among girls by 15 years of age, using published estimates of the expected additional benefits and costs in each country and estimates of the marginal productivity of each healthcare system. We calculated the maximum price each country could afford to pay for HPV vaccination to be cost effective by assessing the net health impact that would be expected to be generated at different potential prices.ResultsAt Gavi negotiated prices, HPV vaccination offers net health benefits across most Gavi-eligible countries included in this study. However, if Gavi-eligible countries faced the average price faced by non-Gavi eligible countries, providing HPV vaccination would result in reduced overall population health in most countries.ConclusionEstimates of the net health impact of providing a healthcare intervention can be used to assess the benefit (or lack of) to countries of adhering to global guidance, inform negotiations with donors, as well as pricing negotiations and the value of developing new healthcare interventions.

Download Full-text

A brief history of economic evaluation for human papillomavirus vaccination policy

Sexual Health ◽

10.1071/sh10018 ◽

2010 ◽

Vol 7 (3) ◽

pp. 352 ◽

Cited By ~ 18

Author(s):

Philippe Beutels ◽

Mark Jit

Keyword(s):

Human Papillomavirus ◽

Economic Evaluation ◽

Policy Making ◽

Cervical Screening ◽

Hpv Vaccination ◽

Health Economic Evaluation ◽

Developed Countries ◽

Economic Evaluations ◽

Human Papillomavirus Vaccination ◽

Screening Programs

Background: This commentary discusses key issues for health economic evaluation and modelling, applied to human papillomavirus (HPV) vaccine programs. Methods: We outline some of the specific features of HPV disease and vaccination, and associated policy questions in light of a literature search for economic evaluations on HPV vaccination. Results: We observe that some policy questions could not be reliably addressed by many of the 43 published economic evaluations we found. Despite this, policy making on universal HPV vaccination followed shortly after vaccine licensure in many developed countries, so the role economic evaluation played in informing these decisions (pre-dating 2008) seems to have been fairly limited. For more recent decisions, however, economic evaluation is likely to have been used more widely and more intensively. Conclusions: We expect future cost-effectiveness analyses to be more instrumental in policy making regarding vaccines covering more HPV types, therapeutic HPV vaccines, and novel diagnostic tests for biomarkers of HPV infection and disease integrated with cervical screening programs.

Download Full-text

One-Dose Human Papillomavirus Vaccination and the Risk of Genital Warts: A Danish Nationwide Population-based Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1067 ◽

2020 ◽

Author(s):

Louise Baandrup ◽

Christian Dehlendorff ◽

Susanne K Kjaer

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccination ◽

Age Groups ◽

Genital Warts ◽

Population Based ◽

Incidence Rates ◽

Real World Data ◽

Calendar Time ◽

Human Papillomavirus Vaccination ◽

The Impact

Abstract Background Increasing evidence suggests that 1-dose human papillomavirus (HPV) vaccination may protect significantly against HPV-related disease. We provide nationwide, real-world data on the risk of genital warts (GWs) after <3 vaccine doses. Methods All Danish women born in 1985–2003 were identified, and individual-level vaccination data were retrieved. The cohort was followed up for first occurrence of GWs until 31 December 2016. Using Poisson regression, we calculated incidence rates (IRs) of GWs per 100 000 person-years and IR ratios (IRRs) with corresponding 95% confidence intervals (CIs) for GWs, according to vaccination status, age at first dose, and calendar time. Results The cohort comprised 1 076 945 girls and women, of whom 485 408 were vaccinated. For girls initiating vaccination at age 12–14 years and 15–16 years, 1-dose vaccine effectiveness (VE) was 71% (IRR = 0.29; 95% CI, .22–.38) and 62% (0.38; .29–.49), respectively, compared with unvaccinated girls. In the same age groups, 2-dose VE was 78% (IRR, 0.22; 95% CI, .18–.26) and 68% (0.32; .26–.38), respectively. After 2009, the IRRs for 3 versus 1 dose and 2 versus 1 dose increased towards unity over calendar time, being 0.69 (95% CI, .57–.84) and 0.86 (.68–1.08) in 2016, respectively. Conclusions In this study, 1 or 2 doses of quadrivalent HPV vaccine was associated with substantial protection against GWs in girls vaccinated at age ≤16 years. The 1-dose VE approached that of 3 or 2 doses over calendar time, probably reflecting the impact of herd protection.

Download Full-text

A Public Health Perspective on HPV Vaccination: Response to The HPV Vaccination Campaign: A Project of Moral Regulation in an Era of Biopolitics

The Canadian Journal of Sociology ◽

10.29173/cjs8977 ◽

2010 ◽

Vol 35 (4) ◽

pp. 627-632 ◽

Cited By ~ 2

Author(s):

Liane Macdonald ◽

Shelley Deeks ◽

Carolyn Doyle

Keyword(s):

Public Health ◽

Santé Publique ◽

Vaccination Campaign ◽

Hpv Vaccination ◽

Promotion De La Santé ◽

Population Based ◽

Public Health Perspective ◽

Vaccination Programs ◽

Time Sensitivity ◽

Sante Publique

Abstract Connell and Hunt’s critique (2010) raises important questions and concerns about human papillomavirus (HPV) vaccination in Canada. We offer a public health perspective on several key issues, including the merits of implementing population-based HPV vaccination programs in Canada; the time-sensitivity of HPV vaccination; and, the non-judgmental approach to sexual health promotion for youth championed by Canadian public health organizations. Résumé La critique de Connell et Hunt (2010) soulève d'importantes questions et préoccupations concernant la vaccination contre le virus du papillome humain (VPH) au Canada. Nous offrons une perspective de santé publique sur quelques questions clés, y compris la raisonnement pour des programmes systématiques de vaccination contre le VPH au Canada, la sensibilité au temps de la vaccination HPV, et l'approche non moralisateur àla promotion de la santé sexuelle pour les jeunes adoptés par les agences de santé publique canadiennes.

Download Full-text

National survey of general practitioners' experience of delivering the National Human Papillomavirus Vaccination Program

Sexual Health ◽

10.1071/sh09135 ◽

2010 ◽

Vol 7 (3) ◽

pp. 291 ◽

Cited By ~ 20

Author(s):

Julia M. L. Brotherton ◽

Julie Leask ◽

Cath Jackson ◽

Kirsten McCaffery ◽

Lyndal J. Trevena

Keyword(s):

Human Papillomavirus ◽

General Practitioners ◽

Hpv Vaccine ◽

Cervical Screening ◽

Hpv Vaccination ◽

Vaccine Safety ◽

Population Based ◽

Vaccination Program ◽

Routine Practice ◽

Human Papillomavirus Vaccination

Background: Between 2007 and 2009, Australian general practitioners (GPs) were involved in implementing a population-based human papillomavirus (HPV) vaccination program. We investigated GPs’ experiences of delivering the HPV vaccine to women aged 18–26. Methods: We posted a survey to 1000 GPs. The survey was informed by 12 domains incorporating constructs from psychological theories that focus on individual and environmental barriers and facilitators to effective implementation of evidence-based practice by health professionals. Results: The response rate was 32%. The 298 vaccinating GPs were positive about HPV vaccine implementation as part of their professional role as a worthwhile initiative within existing general practice infrastructure. They had more negative views about some aspects of program organisation, such as the timelines and potential adverse impacts on cervical screening rates. Vaccine safety was not a key concern. Actual levels of knowledge about HPV were moderate (mean score 3.41 out of 6 (s.d. 0.99)) and contrasted with self-rated knowledge, which was high (93% perceived their knowledge to be adequate). Notably, there were unrealistic expectations about the likely reduction in Pap abnormalities due to vaccination, which is important to clarify to avoid loss of confidence in the vaccine when this reduction does not eventuate. Conclusions: Australian GPs viewed HPV vaccination of women aged 18–26 years as an integrated part of their routine practice, with positive attitudes regarding its benefits and achievability. GPs are well placed to implement mass immunisation programs as long as they are supported by effective and timely communication strategies and resources.

Download Full-text

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.

Download Full-text

Human Papillomavirus Selected Properties and Related Cervical Cancer Prevention Issues

Current Pharmaceutical Design ◽

10.2174/1381612826666200422094205 ◽

2020 ◽

Vol 26 (18) ◽

pp. 2073-2086

Author(s):

Saule Balmagambetova ◽

Andrea Tinelli ◽

Ospan A. Mynbaev ◽

Arip Koyshybaev ◽

Olzhas Urazayev ◽

...

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Prevention ◽

Screening Program ◽

Hpv Infection ◽

Cervical Cancer Prevention ◽

Point Of View ◽

Prevention Strategies ◽

Middle Income ◽

Screening Programs

High-risk human papillomavirus strains are widely known to be the causative agents responsible for cervical cancer development. Aggregated damage caused by papillomaviruses solely is estimated in at least 5% of all malignancies of the human body and 16% in cancers that affect the female genital area. Enhanced understanding of the complex issue on how the high extent of carcinogenicity is eventually formed due to the infection by the Papoviridae family would contribute to enhancing current prevention strategies not only towards cervical cancer, but also other HPV associated cancers. This review article is aimed at presenting the key points in two directions: the current cervical cancer prevention and related aspects of HPV behavior. Virtually all applied technologies related to HPV diagnostics and screening programs, such as HPV tests, colposcopy-based tests (VIA/VILI), conventional and liquid-based cytology, currently available are presented. Issues of availability, advantages, and drawbacks of the screening programs, as well as vaccination strategies, are also reviewed in the article based on the analyzed sources. The current point of view regarding HPV is discussed with emphasis on the most problematic aspect of the HPV family concerning the observed increasing number of highly carcinogenic types. Present trends in HPV infection diagnostics throughout the human fluids and tissues are also reported, including the latest novelties in this field, such as HPV assay/self-sample device combinations. Besides, a brief outline of the related prevention issues in Kazakhstan, the leading country of Central Asia, is presented. Kazakhstan, as one of the post-soviet middle-income countries, may serve as an example of the current situation in those terrains, concerning the implementation of globally accepted cervical cancer prevention strategies. Along with positive achievements, such as the development of a nationwide screening program, a range of drawbacks is also analyzed and discussed.

Download Full-text

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.

Download Full-text

Suicide prevention in low- and middle-income countries: part perceptions, partial solutions

The British Journal of Psychiatry ◽

10.1192/bjp.bp.117.198150 ◽

2017 ◽

Vol 211 (5) ◽

pp. 264-265 ◽

Cited By ~ 2

Author(s):

K. S. Jacob

Keyword(s):

Public Health ◽

Suicide Prevention ◽

Cause Of Death ◽

Population Based ◽

Personal Distress ◽

Public Health Perspective ◽

Middle Income ◽

Common Cause ◽

Middle Income Countries ◽

Low And Middle Income

SummarySuicide, a common cause of death in many low- and middle-income countries, has often been viewed through a medical/psychiatric lens. Such perspectives medicalise social and personal distress and suggest individual and medication-based treatments. This editorial argues for the need to examine suicide from a public health perspective and suggests the need for population-based social and economic interventions.

Download Full-text