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

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.

Validación del instrumento: conocimientos, creencias y aceptación de la vacuna del virus del papiloma humano

Introduction: The human papilloma virus (HPV) is the leading cause of cervical cancer. Having an instrument that measures the acceptance of the HPV vaccine, as well as the factors involved in the acceptance process, is an urgent need for HPV prevention. The objective was to validate the knowledge, beliefs, and acceptance of the human papillomavirus vaccine instrument.Materials and Methods: The validation process was carried out through a descriptive, cross-sectional study and a two-phase process. The population consisted of 393 mothers of girls between the ages of 9 and 11 years, belonging to the State of Puebla, with a non-probabilistic sampling for convenience; the sample was considered at a ratio of 10: 1.Results: A valid and reliable instrument was obtained with a Cronbach's Alpha of .70, a value of p <.000 for Bartlett’s sphericity test, and .82 for the KMO test. In this sense, the factor analysis resulted in a total of 40 items divided into six dimensions.Discussion: The methodological process allowed to have an empirical indicator adapted and validated for the Mexican context, since it is the only one within the context that measures the factors related to the acceptance of the HPV vaccine.Conclusion: We conclude that having an empirical indicator adapted to the Spanish language, which measures acceptance and related factors, is a contribution of great importance to society and an advance in nursing science. Introducción: El virus del papiloma humano es la primera causa de cáncer cervicouterino, contar con un instrumento que mida la aceptación de la vacuna del VPH, así como los factores que intervienen, es una necesidad para la prevención del VPH. El objetivo fue realizar la validación del instrumento conocimientos, creencias y aceptación de la vacuna del virus del papiloma humano.Materiales y Métodos: El proceso de validación se realizó a traves de un estudio descriptivo, transversal y de proceso de dos fases. La población fue de 393 madres de niñas de 9 a 11 años, pertenecientes al Estado de Puebla, con un muestreo no probabilístico por conveniencia, la muestra se consideró por razón de 10:1.Resultados: Se obtuvo un instrumento válido y confiable con un coeficiente de Alfa de Cronbach de .70, un valor de p<.000 para la prueba de esfericidad de Bartlett y la prueba de Kaiser-Meyer Olkin obtuvo un resultado de .82, en este sentido el análisis factorial dio como resultado un total de 40 ítems divididos en seis dimensiones.Discusión: El proceso metodológico permitió contar con un indicador empírico adaptado y valido al contexto mexicano, debido a que es el único dentro del contexto que mide los factores relacionados con la aceptación de la vacuna del virus del papiloma humano.Conclusión: Se concluye que tener un indicador empírico adaptado al idioma español, que mida la aceptación y los factores relacionados, es un aporte de gran importancia para la sociedad y un avance para la ciencia en enfermería.

High Human Papillomavirus Vaccine Acceptability and Cost-Effectiveness of the Chinese 2-Valent Vaccine Among Men Who Have Sex With Men: A Cross-Sectional Study in Shenyang, China

Background: Despite the insupportable burden caused by the human papillomavirus (HPV) and high vaccine acceptability, vaccination programs are not currently available for men who have sex with men (MSM). We aimed to assess HPV infection by examining the willingness for vaccination among MSM and cost-effectiveness of the Chinese 2-valent HPV vaccine.Methods: We recruited MSM in Shenyang, China between July and December 2020 to conduct anal HPV testing and an online survey regarding HPV-related knowledge and vaccine acceptability. We performed a cost-effectiveness analysis to evaluate the incremental cost-effectiveness ratios (ICERs) of the Chinese 2-valent HPV vaccine.Results: A total of 234 participants completed the online survey; of those, 203 were successfully tested for HPV. The median age was 30 years [interquartile range (IQR): 23–38 years]. Most participants had at least undergraduate education (136/234, 58.1%). The acceptability rate for the free HPV vaccine was 57.7% (135/234). The prevalence of HPV types 16 and 18 was 14.9% (18/121) and 26.8% (22/82) in the willing and unwilling to vaccinate groups, respectively (P &gt; 0.05). The prevalence of high-risk HPV among participants aged &lt;30 and ≥50 years was 48.6 and 38.9%, respectively. Using the Chinese per capita gross domestic product (GDP) as a threshold, the Chinese 2-valent HPV vaccine would be a “very cost-effective” strategy, with an ICER value of USD 4,411. This evidence showed that the Chinese 2-valent HPV vaccine was more cost-effective than other imported vaccines.Conclusions: Targeted strategies should be utilized in MSM with different rates of vaccine acceptability. A pilot HPV vaccination program based on the Chinese 2-valent HPV vaccine for MSM is urgently warranted to reduce the burden of HPV and anal cancer.

Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi

Background: Vaccines are among the most effective and cost-efficient public health interventions for promoting child health. However, uptake is considerably affected by vaccine hesitancy. An example is Malawi, with a decline in second vaccine doses and the highest cervical cancer incidence and mortality rate in Sub-Saharan Africa. Understanding vaccine hesitancy is especially important when new vaccines are introduced. This study explores factors contributing to vaccine hesitancy for routine childhood immunization and the human papillomavirus vaccine in Malawi. Methods: The study used a cross-sectional survey design targeting caregivers of children under five years old and adolescent girls. The sample population was derived using three inclusion criteria: one district with low vaccine uptake (Dowa), one district with high vaccine uptake (Salima), and one district where human papillomavirus vaccine was piloted earlier (Zomba). A convenience sample of one primary and one secondary health facility was selected within each district, and participants were systematically included (n = 600). The measures were based on 5C scale for measuring vaccine hesitancy. Multiple regression analyses were performed to explore vaccination intention predictors. Results: Confidence in vaccine safety was the strongest predictor of routine childhood immunization, followed by constraints due to everyday stress. Caregivers had lower confidence in vaccine safety and efficacy when they believed rumors and misinformation and were unemployed. Confidence was higher for those who had more trust in healthcare workers. Age, gender, religion, education, employment, belief in rumors, and trust in healthcare workers were considered predictors of vaccination intention. A husband’s positive attitude (approval) increased childhood vaccination intention. For human papillomavirus, vaccination intentions were higher for those with lower education, more trust in healthcare workers, lower complacency, and a lower tendency toward calculating the benefits and risks of vaccination. Knowledge of human papillomavirus did not increase vaccination intention, but the need to attain a husband’s approval did. Being a young adult and unemployed increased belief in rumors, while trust in healthcare workers reduced the belief. Conclusions: This study provides good insights into the drivers of vaccine hesitancy across different contexts in Malawi. However, further studies are necessary to understand low risk perception among elderly people and the declining trend in second vaccine doses.