Dynamics of genital human papillomavirus in young women.

Contains fulltext : 92743.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 22 maart 2012Promotor : Massuger, L.F.A.G. Co-promotores : Bekkers, R.L.M., Melchers, W.J.G.175 p

Implementation of HPV Self-sampling in Cervical Screening Programs Increases Participation Rates: A Literature Review

IntroductionCervical cancer screening primarily with high risk human papillomavirus (hr-HPV) proved to be more sensitive, in detecting CIN grade 2 or worse (CIN2 +), than the traditional cervical cytology. Primary hr-HPV detection opened up the possibility for vaginal self-sampling, as hr-HPV detection is easy to perform on a vaginal self-sample and showed to be reliable. The aim of this review is to explore the role of HPV self-sampling as a strategy to increase the participation rate in cervical screening programs. MethodsPubMed search on self-sampling HPV; including articles published within last 10 years; Meta-analyse, Randomized Controlled Trial, Review or Systematic Review.ResultsThe literature shows that HPV vaginal self-sampling is feasible, highly acceptable and above all has a high diagnostic accuracy in detecting HPV and CIN2 +. Furthermore, HPV self-sampling followed by Pap smear triage in hr-HPV positive women is cost-effective. Additionally offering mailed self-sample kits, ideally in combination with education, has been proven to improve participation and subsequently CIN2+ detection. ConclusionImplementation of HPV self-sampling in cervical screening programs offers opportunities to reach under screened women, not only in high-income countries, but especially in low- and medium-income countries and among ethnic minority women

[Use of oral contraceptives and increased risk of cervical cancer]

Contains fulltext : 69205.pdf (publisher's version ) (Closed access)A recently published meta-analysis and a large cohort study showed independently that use of oral contraceptives (OC) leads to an increased relative risk (RR) of cervical cancer. This RR increased with the duration of OC use and was 1.90 after 5 years or more (95% CI: 1.69-2.13). The increased RR decreased after cessation of OC use and was normal again Io years later. Longstanding OC use enhances human papillomavirus (HPV) transcription and decreases HPV clearance, resulting in more frequent persistence of HPV, an increase of cervical intraepithelial neoplasia, and an increased RR of cervical cancer. The increase in cervical cancer by OC is, however, associated with a fully compensatory decrease in the incidence of other malignancies, in particular ovarian cancer and endometrial cancer. Based on these findings, there are no reasons to discourage the use of OC by women in the Netherlands

Young adults awareness of HPV and vaccine acceptance after introduction of the HPV vaccine in the Dutch national vaccination program

Item does not contain fulltextPURPOSE: To investigate the effect of implementation of the HPV vaccine on HPV knowledge and HPV vaccine acceptance. METHODS: From June until December 2009 in Nijmegen, the Netherlands, 698 male and female students aged 18-25 years were recruited and interviewed about HPV, cervical carcinoma and HPV vaccine acceptance. RESULTS: Of all participants 46.6% had never heard of HPV. Women and students from the medical faculty were significantly more aware of HPV. Acceptance of a "catch-up" HPV vaccination in women was 51% and in men 27%. Acceptance of the HPV vaccination for 12-year old girls was 79%. CONCLUSION: After implementation of the HPV vaccine in the national vaccination program, > 50% of the students lack knowledge on HPV. Acceptance of a "catch-up" HPV vaccination was low. However, the acceptance of HPV vaccination for 12-year-old girls was high. Vaccine implementation strategies, focusing on 12-16 year old girls, might have caused this difference. Young adults need to be informed that the HPV vaccine may still be efficient when they are sexually active, but HPV 16 and 18 negative

Young adults awareness of HPV and vaccine acceptance after introduction of the HPV vaccine in the Dutch national vaccination program

PURPOSE: To investigate the effect of implementation of the HPV vaccine on HPV knowledge and HPV vaccine acceptance. METHODS: From June until December 2009 in Nijmegen, the Netherlands, 698 male and female students aged 18-25 years were recruited and interviewed about HPV, cervical carcinoma and HPV vaccine acceptance. RESULTS: Of all participants 46.6% had never heard of HPV. Women and students from the medical faculty were significantly more aware of HPV. Acceptance of a "catch-up" HPV vaccination in women was 51% and in men 27%. Acceptance of the HPV vaccination for 12-year old girls was 79%. CONCLUSION: After implementation of the HPV vaccine in the national vaccination program, > 50% of the students lack knowledge on HPV. Acceptance of a "catch-up" HPV vaccination was low. However, the acceptance of HPV vaccination for 12-year-old girls was high. Vaccine implementation strategies, focusing on 12-16 year old girls, might have caused this difference. Young adults need to be informed that the HPV vaccine may still be efficient when they are sexually active, but HPV 16 and 18 negative

Human papillomavirus detection in pregnant women: a prospective matched cohort study

Contains fulltext : 108165.pdf (publisher's version ) (Closed access)Abstract Objective: To study the prevalence, incidence, and clearance of human papillomavirus (HPV) in pregnant and nonpregnant women. Methods: In this prospective matched cohort study, 51 women, became pregnant during follow-up of an HPV epidemiology study (n=2065), and 51 matched nonpregnant women were included. All women provided 3-monthly cervicovaginal self-samples and completed a questionnaire. The PCR SPF(10) LiPA(25) was used for HPV testing. Matching was performed using a propensity score. Results: The cumulative prevalence of high-risk HPV (hrHPV) was 19.6% (n=10) of the pregnant and 17.6% (n=9) of the matched control women. The time point prevalence of any type HPV and hrHPV was not significantly different for pregnant and matched control women. After baseline, there were 10 newly detected hrHPV types in 6 (11.8%) of the pregnant women, and there were 11 newly detected hrHPV types in 8 (15.7%) of the matched control women. There was no difference in HPV clearance between pregnant and matched control women. Conclusions: This study shows that in a low-parity population of young, unscreened women, pregnancy does not seem to influence HPV prevalence, incidence, and clearance

Young adults and acceptance of the human papillomavirus vaccine.

Contains fulltext : 69353.pdf (publisher's version ) (Closed access)OBJECTIVES: To determine whether young Dutch adults had ever heard of human papillomavirus (HPV) and whether they would accept vaccination, and to assess the factors influencing their decision. STUDY DESIGN: Cross-sectional survey. METHODS: Six hundred participants aged 18-25 years were recruited from two university departments and one non-university technical college. RESULTS: One hundred and six (17.7%) participants had heard of HPV and 536 (94%) had heard of cervical carcinoma. Women had significantly more knowledge of cervical carcinoma than men. A medical education, knowledge of HPV, knowledge of cervical cancer and knowledge of the cervical screening programme were not significantly associated with acceptance of HPV vaccination, whereas gender and age did show a significant relationship. In total, 61% of the female participants and 48% of the male participants were willing to accept a 'catch-up' HPV vaccination. CONCLUSIONS: This study found that average knowledge levels of HPV and cervical cancer were low. Despite this lack of knowledge, a small majority of the study population would accept a 'catch-up' HPV vaccination. Women and younger participants were significantly more willing to accept HPV vaccination. However, in these subgroups, acceptance of HPV vaccination seems to be affected by other, still unidentified, factors. These factors could be evaluated in a more qualitative orientated study. An educational campaign is needed to cover knowledge about HPV and cervical carcinoma, and beliefs and behaviours associated with the acceptance of vaccination

Co-administration of human papillomavirus-16/18 AS04-adjuvanted vaccine with hepatitis B vaccine: randomized study in healthy girls.

Item does not contain fulltextBACKGROUND: To evaluate co-administration of GlaxoSmithKline Biologicals' human papillomavirus-16/18 AS04-adjuvanted vaccine (HPV) and hepatitis B vaccine (HepB). METHODS: This was a randomized, controlled, open, multicenter study. Healthy girls, aged 9-15 years, were randomized to receive HPV (n=247), HepB (n=247) or HPV co-administered with HepB (HPV+HepB; n=247) at Months 0, 1 and 6. Antibodies against hepatitis B surface antigen (HBs), HPV-16 and HPV-18 were measured, and reactogenicity and safety monitored. Co-primary objectives were to demonstrate non-inferiority of hepatitis B and HPV-16/18 immune responses at Month 7 for co-administered vaccines, compared with vaccines administered alone, in the according-to-protocol cohort. RESULTS: The pre-defined criteria for non-inferiority were met for all co-primary immunogenicity endpoints at Month 7. Anti-HBs seroprotection rates >/=10mIU/mL were achieved by 97.9% and 100% of girls, respectively, following co-administration or HepB alone. Anti-HBs geometric mean titers (GMTs) (95% confidence interval) were 1280.9 (973.3-1685.7) and 3107.7 (2473.1-3905.1) milli-international units/mL, respectively. Anti-HPV-16 and -18 seroconversion rates were achieved by >/=99% of girls following co-administration or HPV alone. Anti-HPV-16 GMTs were 19819.8 (16856.9-23303.6) and 21712.6 (19460.2-24225.6) ELISA units (ELU)/mL, respectively. Anti-HPV-18 GMTs were 8835.1 (7636.3-10222.1) and 8838.6 (7948.5-9828.4) ELU/mL, respectively. Co-administration was generally well tolerated. CONCLUSIONS: The study results support the co-administration of HPV-16/18 AS04-adjuvanted vaccine with hepatitis B vaccine in adolescent girls aged 9-15 years. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov registration number NCT00652938

Screening for persistent high-risk HPV infections may be a valuable screening method for young women; A retrospective cohort study

Contains fulltext : 197712.pdf (publisher's version ) (Open Access