Attitudinal and socio-structural determinants of cervical cancer screening and HPV vaccination uptake: a quantitative multivariate analysis

Aim: The introduction of the human papillomavirus (HPV) vaccine enables for the first time in the history of cancer prevention the possibility of combating the major cause of a cancer even before its onset. The secondary prevention measure of cervical cancer screening has thus been complemented by a primary prevention measure. The aim of this study is to analyse the determinants of uptake of preventive measures against cervical cancer as a basis for comparing the determinants of screening attendance with those of HPV vaccination attendance. Subject and methods: A population-based representative survey comprising 760 randomly selected women aged 14 to 65 was performed in the German federal state of Mecklenburg-Western Pomerania. Prevention behaviour, attitudes towards cervical cancer screening and HPV vaccination, and knowledge about cervical cancer and HPV were investigated by means of a structured questionnaire. Descriptive analyses and multivariate logistic regression analyses were conducted to identify the determinants of screening and HPV vaccine uptake. Results: Attendance both at screening and at HPV vaccination was best predicted by attitudinal factors. Positive connotations of cancer prevention measures and utility expectations, fear of cancer and high subjective risk perception were conducive to attendance at screening and HPV vaccination. Screening attendance was less regular among women of lower socioeconomic status. In contrast, HPV vaccination uptake was higher for young women with lower educational attainment and lower social class. Knowledge did not impact prevention behaviour significantly. There is no trade-off between screening and vaccination attendance; the vast majority of respondents was aware of the necessity of regular screening attendance even when vaccinated against HPV. Conclusions: Uptake rates for existing primary and secondary prevention measures against cervical cancer can be enhanced by fostering perceptions of utility and positive connotations of regular screening and becoming vaccinated against HPV. Elderly women in particular should be encouraged to attend screening by means of a recall system. Given the low overall level of knowledge about cervical cancer and its risk factors, there is a need for education about the necessity and utility of prevention to reach women of all social classes

The impact of viral mutations on recognition by SARS-CoV-2 specific T cells.

We identify amino acid variants within dominant SARS-CoV-2 T cell epitopes by interrogating global sequence data. Several variants within nucleocapsid and ORF3a epitopes have arisen independently in multiple lineages and result in loss of recognition by epitope-specific T cells assessed by IFN-γ and cytotoxic killing assays. Complete loss of T cell responsiveness was seen due to Q213K in the A∗01:01-restricted CD8+ ORF3a epitope FTSDYYQLY207-215; due to P13L, P13S, and P13T in the B∗27:05-restricted CD8+ nucleocapsid epitope QRNAPRITF9-17; and due to T362I and P365S in the A∗03:01/A∗11:01-restricted CD8+ nucleocapsid epitope KTFPPTEPK361-369. CD8+ T cell lines unable to recognize variant epitopes have diverse T cell receptor repertoires. These data demonstrate the potential for T cell evasion and highlight the need for ongoing surveillance for variants capable of escaping T cell as well as humoral immunity.This work is supported by the UK Medical Research Council (MRC); Chinese Academy of Medical Sciences(CAMS) Innovation Fund for Medical Sciences (CIFMS), China; National Institute for Health Research (NIHR)Oxford Biomedical Research Centre, and UK Researchand Innovation (UKRI)/NIHR through the UK Coro-navirus Immunology Consortium (UK-CIC). Sequencing of SARS-CoV-2 samples and collation of data wasundertaken by the COG-UK CONSORTIUM. COG-UK is supported by funding from the Medical ResearchCouncil (MRC) part of UK Research & Innovation (UKRI),the National Institute of Health Research (NIHR),and Genome Research Limited, operating as the Wellcome Sanger Institute. T.I.d.S. is supported by a Well-come Trust Intermediate Clinical Fellowship (110058/Z/15/Z). L.T. is supported by the Wellcome Trust(grant number 205228/Z/16/Z) and by theUniversity of Liverpool Centre for Excellence in Infectious DiseaseResearch (CEIDR). S.D. is funded by an NIHR GlobalResearch Professorship (NIHR300791). L.T. and S.C.M.are also supported by the U.S. Food and Drug Administration Medical Countermeasures Initiative contract75F40120C00085 and the National Institute for Health Research Health Protection Research Unit (HPRU) inEmerging and Zoonotic Infections (NIHR200907) at University of Liverpool inpartnership with Public HealthEngland (PHE), in collaboration with Liverpool School of Tropical Medicine and the University of Oxford.L.T. is based at the University of Liverpool. M.D.P. is funded by the NIHR Sheffield Biomedical ResearchCentre (BRC – IS-BRC-1215-20017). ISARIC4C is supported by the MRC (grant no MC_PC_19059). J.C.K.is a Wellcome Investigator (WT204969/Z/16/Z) and supported by NIHR Oxford Biomedical Research Centreand CIFMS. The views expressed are those of the authors and not necessarily those of the NIHR or MRC