Novedades en el calendario de vacunas de Argentina. Segunda parte: virus del papiloma humano / News in Argentina's vaccine schedule. Second part: human papillomavirus

A fines de 2023 la autoridad sanitaria de Argentina realizó modificaciones en el Calendario Nacional obligatorio, que serán implementadas en forma progresiva durante 2024. Este artículo está enfocado en la reducción del esquema contra el virus del papiloma humano. (AU)

At the end of 2023, the Argentine health authority modified the mandatory National Calendar, which will be implemented progressively during 2024. This article focuses on the reduction in the human papillomavirus scheme. (AU)

Comparación de protocolos de vacunación contra el virus del papiloma humano en Ecuador y América Latina / Comparation of vaccination protocols against the human papillomavirus in Ecuador and Latin America

INTRODUCCIÓN: El virus del papiloma humano (VPH), con más de 100 tipos, es de transmisión sexual. Varios países de América Latina han introducido las vacunas contra el VPH. Aunque América Latina es la región que más rápido avanzó en la vacunación contra el VPH, sus sistemas de seguimiento y vigilancia son aún deficientes. OBJETIVO: Comparar las diferentes estrategias de vacunación contra el VPH en Ecuador y América Latina. MÉTODO: Revisión bibliográfica, en la que se obtuvo información de documentos gubernamentales y artículos indexados en los últimos 5 años sobre las estrategias de vacunación contra el VPH en Ecuador y América Latina. RESULTADOS: La mayoría de los países de América Latina han logrado introducir la vacuna contra el VPH, excepto Venezuela, Martinica, Haití, Nicaragua y Cuba. CONCLUSIONES: Los protocolos de vacunación de Ecuador y América Latina necesitan mejorar sus sistemas de seguimiento y aumentar la expansión de datos de cobertura disponibles de manera consistente. Actualmente siguen existiendo desafíos para introducir las vacunas, lograr una alta cobertura y fortalecer el seguimiento, la evaluación y la notificación.

INTRODUCTION: The human papilloma virus (HPV), with more than 100 types, is a sexual transmission infection. Many Latin American countries have introduced the vaccines against the HPV. Although Latin América is the region which advanced faster against the HPV, its surveillance and follow-up systems are yet deficient. OBJECTIVE: To compare the different strategies to assume the vaccination against the HPV in Ecuador and Latin America. METHOD: Bibliographic review, in which information was obtained from government documents and articles indexed in the last five years on vaccination strategies against HPV in Ecuador and Latin America. RESULTS: Most Latin American countries have managed to introduce the vaccine against the HPV, except Venezuela, Martinica, Haiti, Nicaragua and Cuba. CONCLUSIONS: The vaccination protocols of Ecuador and Latin América need to improve their systems of follow-up and monitoring, and increase the expansion of available data in a consistent manner. Now, there are still existing challenges to introduce the vaccines, manage a high reach and fortify the follow-up, the evaluation, and the notification.

Papiloma Conjuntival: revisión bibliográfica / Conjunctival Papilloma: a literature review

Objetivo: El objetivo de la realización del presente artículo de revisión bibliográfica es analizar las características del Papiloma conjuntival como: el pronóstico, prevalencia, relación con el VPH, diagnóstico, tratamiento e importancia que representa la presencia del mismo. Métodos: El siguiente artículo se realizó mediante la búsqueda de artículos científicos en español e inglés, mismos que fueron obtenidos a través de base de datos como Scopus, PubMed y Google Academic. Se hizo usó de la plataforma virtual de la biblioteca católica de Cuenca utilizando comandos de búsqueda avanzada (""), AND, OR. Finalmente se incluyeron 15 artículos dentro de la revisión bibliográfica. Para el trabajo conjunto de los colaboradores se hizo uso de la plataforma Google Drive. Resultados: Papiloma conjuntival es un tumor de células escamosas benigno de la conjuntiva con una tendencia mínima a la malignidad. Estos tumores están relacionados con el VPH específicamente los tipos VI y XI. Para obtener un diagnóstico es importante realizar una anamnesis y un examen oftalmológico exhaustivo, una biopsia posterior a la extirpación de la lesión, la tomografía de coherencia óptica de alta definición (HR-OCT), y la biomicroscopia ultrasónica (UBM). El MSP, ha elaborado una iniciativa denominada "Programa Ampliado de Inmunizaciones (PAI)", mismo que consiste en el proceso de vacunación de la población femenina de 9, 10 y 11 años pertenecientes a escuelas públicas y privadas. Conclusiones: Es importante que las instituciones educativas fomenten más la salud ocular porque al momento de que existe un contagio de VPH hay riesgo de tener papiloma conjuntival y las personas desconocen este medio de transmisión. Además, se debe promover la vacunación en niños porque cualquier género es propenso a adquirir el VPH

Objective: The aim of this literature review article is to analyze the characteristics of: conjunctival papilloma such as prognosis, prevalence, relationship with HPV, diagnosis, treatment and importance of its presence. Methods: The following article was carried out by searching scientific articles in Spanish and English, which were obtained through databases such as Scopus, PubMed and Google Academic. We used the virtual platform of the Catholic Library of Cuenca using advanced search commands (""), AND, OR. Finally, 15 articles were included in the biliographic review. For the joint work of the collaborators, use was made of the Google Drive platform. Results: Conjunctival papilloma is a benign squamous cell tumor of the conjunctiva with a minimal tendency to malignancy. These tumors are related to HPV specifically types VI and XI. To obtain a diagnosis it is important to perform a thorough anamnesis and ophthalmologic examination, a biopsy after removal of the lesion, high-definition optical coherence tomography (HR-OCT), and ultrasonic biomicroscopy (UBM). The MSP has developed an initiative called "Expanded Program of Immunizations (PAI)", same that consists of the vaccination process of the female population of 9, 10 and 11 years old belonging to public and private schools. Conclusions: It is important that educational institutions promote more eye health because when there is an HPV infection there is a risk of having conjunctival papilloma and people are unaware of this means of transmission. In addition, vaccination should be promoted in children because any gender is prone to acquire HPV.

Epidemiological surveillance of Human Papillomavirus (HPV) genotypes in oral and genital tracts and the impact of HPV vaccination on male university students from Rio de Janeiro state, Brazil / Vigilância Epidemiológica dos genótipos de papilomavírus humano (HPV) nos tratos oral e genital e o impacto da vacinação em estudantes universitários do sexo masculino do estado do Rio de Janeiro, Brasil

Introduction: Human Papillomavirus (HPV) infections are of significant concern in men, given its potential impact on their health and the risk of transmission to partners. Understanding and addressing this infection in men is crucial to evaluate the effectiveness of vaccination in reducing HPV-related diseases. Objective: To assess the impact of HPV vaccination, potential genotype shifts, and adverse effects, through a prospective study conducted with male university students. Methods:The study involved 286 volunteers who were examined at Sexually Transmitted Disease Clinics at the Universidade Federal Fluminense in Niterói, Rio de Janeiro, Brazil. The HPV prevalence was evaluated using generic PCR, genotyped by DNA microarray and monitored adverse effects. Results: The findings of this study revealed the absence of moderate or severe adverse effects. Genetic shifts were observed, including the disappearance of oncogenic HPV types 16 and 18. Surprisingly, even after completing the full vaccine regimen, students still harbored HPV11 in the oral tract. Furthermore, persistent HPV 6 and 11 infections were identified in three students, who had pre-existing infections prior to vaccination, at the follow-up visit. Multivariate analysis uncovered independent associations, notably an increased risk of HPV infection in the oral tract among men who have sex with men. HPV prevalence rates remained low both before and after the vaccination scheme (T0: 14.7%, T1: 8.7%). Even after the full vaccination scheme, the prevalence remained similar at T2 (14.6%), with no statistically significant differences recorded. HPV11 emerged as the most prevalent type throughout the study, followed by HPV6. Vaccine genotypes were detected in a significant proportion of samples at T0 (85.4%), T1 (89.5%), and T2 (100%). Conclusion: Overall, this study suggests that vaccination may represent a promising approach to reducing HPV-related health risks. These findings shed light on the potential benefits and challenges of HPV vaccination, emphasizing the need for continued monitoring and vaccination efforts

Introdução: As infecções por papilomavírus humano (HPV) são de grande preocupação em homens, dada sua possível influência na saúde deles e no risco de transmissão para parceiros. Compreender e abordar essa infecção em homens é fundamental para avaliar a eficácia da vacinação na redução de doenças relacionadas ao HPV. Objetivo: Avaliar o impacto da vacinação contra o HPV, possíveis alterações genotípicas e efeitos adversos, por meio de um estudo prospectivo realizado em estudantes universitários do sexo masculino. Métodos: O estudo envolveu 286 voluntários examinados em Clínicas de Doenças Sexualmente Transmissíveis na Universidade Federal Fluminense, em Niterói, Rio de Janeiro, Brasil. A prevalência do HPV foi avaliada por polymerase chain reaction (PCR) genérico e genotipada por microarranjo de DNA, e foram monitorados os efeitos adversos. Resultados: Os resultados deste estudo revelaram a ausência de efeitos adversos moderados ou graves. Observaram-se mudanças genéticas, incluindo o desaparecimento dos tipos oncogênicos do HPV 16 e 18. Surpreendentemente, mesmo após a conclusão do esquema completo de vacinação, os estudantes ainda abrigavam o HPV 11 na cavidade oral. Além disso, foram identificadas infecções persistentes pelo HPV 6 e 11 em três estudantes que já tinham infecções preexistentes antes da vacinação e na visita de acompanhamento. A análise multivariada revelou associações independentes, especialmente um aumento no risco de infecção pelo HPV na cavidade oral em homens que têm relações sexuais com homens. As taxas de prevalência do HPV permaneceram baixas tanto antes quanto depois do esquema de vacinação (T0: 14,7%, T1: 8,7%). Mesmo após a conclusão do esquema de vacinação, a prevalência permaneceu semelhante em T2 (14,6%), sem diferenças estatisticamente significativas registradas. O HPV 11 emergiu como o tipo mais prevalente ao longo do estudo, seguido pelo HPV 6. Genótipos da vacina foram detectados em uma proporção significativa de amostras em T0 (85,4%), T1 (89,5%) e T2 (100%). Conclusão: No geral, este estudo sugere que a vacinação pode representar uma abordagem promissora para a redução dos riscos à saúde relacionados ao HPV. Esses achados lançam luz sobre os benefícios e desafios potenciais da vacinação contra o HPV, enfatizando a necessidade de monitoramento contínuo e esforços de vacinação

Expert consensus on the immunization strategy and practice of human papillomavirus vaccine for female adolescents in the Yangtze River Delta region / 中华预防医学杂志

Persistent infection of high-risk human papillomavirus (HPV) is the leading cause of cervical cancer. In order to achieve the goal of cervical cancer elimination, the World Health Organization (WHO) proposed the "90-70-90" goal, one of which is "90% of girls fully vaccinated with HPV vaccine by age 15 years". Based on the epidemiological characteristics of HPV infection and the characteristics of HPV vaccine, it is important to give priority to female adolescents to be vaccinated with HPV vaccine. CAV Affiliated Association for Standardized Management and Practice of Immunization Program organized an expert group to develop an expert consensus on the immunization strategy and practice of human papillomavirus vaccine for female adolescents in the Yangtze River Delta region. This consensus introduces HPV infection and related disease burden, safety, efficacy and effectiveness of HPV vaccination for female adolescents, factors affecting the health benefits of HPV vaccination for female adolescents, current HPV vaccination strategies for female adolescents, the expert advice, common problems and precautions in the Yangtze River Delta region. This consensus is developed to guide HPV vaccination for female adolescents in the Yangtze River Delta region and provide reference for other regions.

Improved population coverage of the human papillomavirus vaccine after implementation of a school-based vaccination programme: the Singapore experience

INTRODUCTION@#Cervical cancer has a high disease burden in Singapore, and it is strongly associated with human papillomavirus (HPV) infections. Despite constant efforts to encourage vaccination, local HPV vaccine uptake remains low. Universal mass vaccination is a proven cost-effective method to reduce the cervical cancer disease burden. This paper reviews the newly implemented school-based HPV vaccination programme in Singapore and the factors that led to its success.@*METHODS@#Fully subsidised HPV vaccinations were offered to all Secondary 1 female students on an opt-in basis, starting as a rollout dose in 2019. One-time catchup vaccination was also offered to female students in Secondary 2-5. Eligible recipients were identified using enrolment data provided by Ministry of Education schools. A total of 19,144 students across 139 schools were offered the rollout dose, and 20,854 students across 140 schools were offered the catchup doses.@*RESULTS@#High vaccine uptake rates of 80.6%-87.3% were noted with the introduction of the school-based programme, translating to high vaccine coverage of 90.3%-93.4%. Only a small proportion of students (1.5%-1.9% per cohort) opted out. The rate of reported side effects, which were commonly known effects, was low at one in 1000. Among the students who reported side effects, those who received the second vaccine dose did so uneventfully.@*CONCLUSION@#High HPV vaccine coverage was achieved after implementation of the school-based immunisation programme. Timely assessment of knowledge lapses and targeted intervention, strong partnerships with stakeholders, constant on-site adaptation and positive social influence contributed to its success. This model can be applied to future school health programmes.

Infection of human papillomavirus and head and neck cancer / 中华肿瘤杂志

High-risk human papillomavirus (HPV)-related cancers consist of cervical cancer, anal cancer, penile cancer, vulvar cancer, vaginal cancer, and head and neck cancer (HNC). Of these, the disease burden of HNC is second only to cervical cancer. HNC mostly originates from malignant lesions of squamous epithelial cells and mainly includes oral cavity cancer, pharyngeal cancer (including nasopharyngeal cancer, oropharyngeal cancer, and hypopharyngeal cancer), and laryngeal cancer. Tobacco use, alcohol abuse, and HPV infection are three primary risk factors. Recently, there is an upward trend of HNC incidence globally, especially in high-income countries. In China, the disease burden and trends of HPV-related HNC are still not clear. A few small sample size and single-center studies suggest a high HPV prevalence and increasing trend in HNC. Methodological differences in HPV testing and regional variabilities still exist among these studies. Among the anatomic sites, oropharyngeal cancer has been shown to be caused by HPV infection, but the association of HPV with other sites is still under debate. In addition, there is a paucity of relevant studies. Here, this review narrates the association between HPV infection and HNC, compares the differences between global and Chinese studies, and then explores the importance of HPV infection in various anatomical sites. The main objective is to highlight the research on HPV-related HNC and promote relevant prevention and treatment programs.

Current status of clinical trials of HPV therapeutic vaccines / 中华预防医学杂志

Cervical cancer mainly caused by human papillomavirus (HPV) infection has become a public health issue, which seriously threatens women 's health. To prevent HPV infection, the currently used prophylactic vaccines mainly induce a humoral immune response in the host, thereby generating neutralizing antibodies. In contrast, the design goal of therapeutic HPV vaccines is to induce a cell-mediated immune response in the host, primarily driven by Th1 cells, aiming to clear existing viral infections and slow down or inhibit tumor progression. Currently, several therapeutic HPV vaccines based on different mechanisms and techniques have entered clinical trials. This review will summarize the progress of these clinical trials, providing reference for the research and development of therapeutic HPV vaccines.

A systematic review in health economics research on the expansion of human papilloma virus vaccination population to men / 中华预防医学杂志

Objective: To systematically collect and evaluate the health economics research of Human papilloma virus(HPV) vaccination population expansion to men, and to provide evidence for optimizing HPV vaccine immunization strategies. Methods: Health economics research studies on male HPV vaccination published in databases including PubMed, Web of Science, CNKI, and Wanfang Database from January 2010 to September 2022 were collected according to the systematic evaluation research design. The quality of the studies was assessed using the health economics evaluation reporting standards (2022 edition) (CHEERS 2022), with full score of 28. The results of the studies were reviewed and analyzed systematically. Results: A total of 21 studies complies with the criteria were included, all of which was foreign research. The average CHEERS score of the literatures was 25.71 points, range from 23 to 28 points. 85.71% (12/14) studies of the gender-neutral population showed that including male in HPV vaccination were more consistent with the cost effectiveness than female vaccination alone under certain conditions (target at adolescents of 10 to 15 years old or adults under 26 years old). 80.00% (4/5) of the studies target at ordinary men only were proved that male vaccination with HPV vaccine was in line with the cost-effectiveness. 2 studies targeting men who have sex with men (MSM) were both concluded that it met the cost-effectiveness. In addition, the results of 2 gender-neutral population studies and 1 study on men alone showed that extending HPV vaccination to men did not conform to cost effectiveness. The main reasons for the non-cost-effectiveness included the high price of vaccines and the age of vaccination. Conclusion: The quality of the health economics evaluation studies on expanding HPV vaccination to the male population is high. Vaccination targeting adolescents and young men as well as special groups (such as MSM) are likely to be cost-effective, and vaccinations for other groups are still need further evaluated. It is recommended that relevant research should be conducted to provide evidence for expanding the scope of HPV vaccination to men in China.

Analysis of the current status and related factors of human papillomavirus infection among community-dwelling women aged 18-24 years without a history of vaccination in Shanghai City / 中华预防医学杂志

Objective: To understand the status of human papillomavirus (HPV) infection among young women without a history of vaccination in Shanghai, and analyze the related factors of HPV infection in this population. Methods: A total of 2 660 women aged 18-24 years old who had made an appointment for HPV vaccine at 36 community health service centers in Shanghai from July 2022 to February 2023 were selected as the study subjects. Basic information (including demographic characteristics, previous disease history, female menstrual and reproductive history, sexual life history, etc.) was collected by a self-filling electronic questionnaire. Cervical secretions were detected by HPV nucleic acid typing. The multivariate logistic regression model was used to analyze the factors related to high-risk HPV (HR-HPV) infection in the target population. Results: The age of the subjects was (23±1) years old, and the infection rate of HPV was 14.51% (386 cases), among which the infection rates of HR-HPV and low-risk HPV were 13.53% (360 cases) and 1.84% (49 cases), respectively. The main subtypes of HR-HPV infection were HPV52, 16, 58, 39 and 66. The multivariate logistic regression model analysis showed that compared with the control group, the OR (95%CI) values for HR-HPV infection in the group of married, earned less than 2 000 yuan/month, drank alcohol occasionally, gynecological disease history, had two or more sexual partners in the past year, and did not know whether the partners had other sexual partners were 0.41 (0.25-0.66), 0.39 (0.21-0.70), 1.45 (1.13-1.86), 1.29 (1.00-1.66), 2.18-5.18 (1.02-16.05), and 1.82 (1.31-2.54), respectively. Conclusion: The infection rate of HPV among women aged 18-24 years old in Shanghai remains at a high level. The main subtypes of HR-HPV infection are HPV52, 16, 58, 39 and 66. The marital status, economic income level, drinking status, gynecological disease history and sexual life history are related to HR-HPV infection.

Current status of clinical trials of HPV therapeutic vaccines / 中华预防医学杂志

Cervical cancer mainly caused by human papillomavirus (HPV) infection has become a public health issue, which seriously threatens women 's health. To prevent HPV infection, the currently used prophylactic vaccines mainly induce a humoral immune response in the host, thereby generating neutralizing antibodies. In contrast, the design goal of therapeutic HPV vaccines is to induce a cell-mediated immune response in the host, primarily driven by Th1 cells, aiming to clear existing viral infections and slow down or inhibit tumor progression. Currently, several therapeutic HPV vaccines based on different mechanisms and techniques have entered clinical trials. This review will summarize the progress of these clinical trials, providing reference for the research and development of therapeutic HPV vaccines.

A systematic review in health economics research on the expansion of human papilloma virus vaccination population to men / 中华预防医学杂志

Objective: To systematically collect and evaluate the health economics research of Human papilloma virus(HPV) vaccination population expansion to men, and to provide evidence for optimizing HPV vaccine immunization strategies. Methods: Health economics research studies on male HPV vaccination published in databases including PubMed, Web of Science, CNKI, and Wanfang Database from January 2010 to September 2022 were collected according to the systematic evaluation research design. The quality of the studies was assessed using the health economics evaluation reporting standards (2022 edition) (CHEERS 2022), with full score of 28. The results of the studies were reviewed and analyzed systematically. Results: A total of 21 studies complies with the criteria were included, all of which was foreign research. The average CHEERS score of the literatures was 25.71 points, range from 23 to 28 points. 85.71% (12/14) studies of the gender-neutral population showed that including male in HPV vaccination were more consistent with the cost effectiveness than female vaccination alone under certain conditions (target at adolescents of 10 to 15 years old or adults under 26 years old). 80.00% (4/5) of the studies target at ordinary men only were proved that male vaccination with HPV vaccine was in line with the cost-effectiveness. 2 studies targeting men who have sex with men (MSM) were both concluded that it met the cost-effectiveness. In addition, the results of 2 gender-neutral population studies and 1 study on men alone showed that extending HPV vaccination to men did not conform to cost effectiveness. The main reasons for the non-cost-effectiveness included the high price of vaccines and the age of vaccination. Conclusion: The quality of the health economics evaluation studies on expanding HPV vaccination to the male population is high. Vaccination targeting adolescents and young men as well as special groups (such as MSM) are likely to be cost-effective, and vaccinations for other groups are still need further evaluated. It is recommended that relevant research should be conducted to provide evidence for expanding the scope of HPV vaccination to men in China.

Analysis of the current status and related factors of human papillomavirus infection among community-dwelling women aged 18-24 years without a history of vaccination in Shanghai City / 中华预防医学杂志

Objective: To understand the status of human papillomavirus (HPV) infection among young women without a history of vaccination in Shanghai, and analyze the related factors of HPV infection in this population. Methods: A total of 2 660 women aged 18-24 years old who had made an appointment for HPV vaccine at 36 community health service centers in Shanghai from July 2022 to February 2023 were selected as the study subjects. Basic information (including demographic characteristics, previous disease history, female menstrual and reproductive history, sexual life history, etc.) was collected by a self-filling electronic questionnaire. Cervical secretions were detected by HPV nucleic acid typing. The multivariate logistic regression model was used to analyze the factors related to high-risk HPV (HR-HPV) infection in the target population. Results: The age of the subjects was (23±1) years old, and the infection rate of HPV was 14.51% (386 cases), among which the infection rates of HR-HPV and low-risk HPV were 13.53% (360 cases) and 1.84% (49 cases), respectively. The main subtypes of HR-HPV infection were HPV52, 16, 58, 39 and 66. The multivariate logistic regression model analysis showed that compared with the control group, the OR (95%CI) values for HR-HPV infection in the group of married, earned less than 2 000 yuan/month, drank alcohol occasionally, gynecological disease history, had two or more sexual partners in the past year, and did not know whether the partners had other sexual partners were 0.41 (0.25-0.66), 0.39 (0.21-0.70), 1.45 (1.13-1.86), 1.29 (1.00-1.66), 2.18-5.18 (1.02-16.05), and 1.82 (1.31-2.54), respectively. Conclusion: The infection rate of HPV among women aged 18-24 years old in Shanghai remains at a high level. The main subtypes of HR-HPV infection are HPV52, 16, 58, 39 and 66. The marital status, economic income level, drinking status, gynecological disease history and sexual life history are related to HR-HPV infection.

Importance of vaccination against human papillomavirus in a rural settlement in Terenos, Mato Grosso do Sul / Importância da vacinação contra o papilomavírus humano em um assentamento rural em Terenos, Mato Grosso do Sul

ABSTRACT OBJECTIVE To understand health professionals' perceptions about vaccination against human papillomavirus (HPV) in the Santa Mônica rural settlement in Terenos, Mato Grosso do Sul. METHODS Quantitative and qualitative methodologies, consultations on vaccination cards, records of community health agents and the focus group technique were used. The main factors of hesitation and vaccine refusal were analyzed, as well as the health team's strategies for the process of immunization against HPV, from June to August 2018. RESULTS Of 121 children and adolescents, 81 (66.94%) received the complete vaccination schedule. Complete vaccination coverage for women was 73.17% (60/82) and for men, 53.8% (21/39). It was observed that, although strategies are adopted for vaccine promotion, such as mobile actions, the public is resistant due to superficial knowledge about the vaccine and its use in an early age group, showing itself to be susceptible to the negative influence of the media and to society's taboos. In addition, difficulties regarding the use of the Unified Health System card and the shortage of professionals were also observed. CONCLUSION The results explain the immunization coverage below the target and reinforce the need to strengthen the family health strategy, as well as the permanent and continuing education of professionals, in order to increase parental confidence and adherence to vaccination.

RESUMO OBJETIVO Compreender as percepções dos profissionais de saúde acerca da vacinação contra o papilomavírus humano (HPV) no Complexo de assentamentos Santa Mônica, em Terenos, Mato Grosso do Sul. MÉTODOS Foram utilizadas metodologias quanti-qualitativas, consultas em cartões vacinais, registros de agente comunitários de saúde e a técnica de grupo focal. Foram analisados os principais fatores de hesitação e recusa vacinal, bem como as estratégias da equipe de saúde para o processo de imunização contra o HPV, de junho a agosto de 2018. RESULTADOS De 121 crianças e adolescentes, 81 (66,94%) receberam o esquema vacinal completo. A cobertura vacinal completa feminina foi de 73,17% (60/82) e a masculina de 53,8% (21/39). Observou-se que, embora sejam adotadas estratégias para a promoção da vacina, como ações volantes, o público encontra-se resistente devido ao conhecimento superficial sobre a vacina e sua utilização em faixa etária precoce, mostrando-se suscetível à influência negativa da mídia e aos tabus da sociedade. Além disso, dificuldades quanto ao uso do cartão do Sistema Único de Saúde e a escassez de profissionais também foram observadas. CONCLUSÃO Os resultados justificam a cobertura vacinal abaixo da meta e reforçam a necessidade de fortalecimento da estratégia de saúde da família, bem como da educação permanente e continuada dos profissionais, a fim de aumentar a confiança dos pais e a adesão à vacinação.

Papiloma humano según la percepción de estudiantes universitarios / Human papilloma according to the perception of university students

El objetivo del presente estudio fue determinar el conocimiento sobre el Virus del Papiloma Humano (VPH) en estudiantes universitarios de la ciudad de Guayaquil, Se realizó una investigación con alcance descriptivo y transaccional, con una población constituida por 3000 estudiantes universitarios, y una muestra probabilística de 332. La técnica empleada fué la encuesta y el instrumento de recolección de la información, un cuestionario con 15 preguntas. El conocimiento de esta enfermedad se determinó mediante una escala de valoración en las siguientes categorías: Insuficiente: de 1-3; Regular: 4-6; Bueno: 7-9; Muy Bueno; 10-12 y Excelente: 13-15. Se realizó la prueba de Kolmogorov- Smirnov para determinar la normalidad de la distribución de datos y la prueba del Chi-cuadrado para la comprobación de las hipótesis planteadas, los datos se procesaron con el paquete estadístico SPSS 21,0. Se concluye que existe una asociación significativa entre el grado de conocimiento del papiloma humano con la edad y el sexo de los estudiantes universitarios(AU)

The objective of the present study was to determine the knowledge about the Human Papilloma Virus (HPV) in university students in the city of Guayaquil. An investigation with a descriptive and cross-sectional scope was carried out, with a population made up of 3000 university students, and a probabilistic sample of 332. The technique used was the survey and the data collection instrument, a questionnaire with 15 questions. Knowledge of this disease was determined using an assessment scale in the following categories: Insufficient: 1-3; Regular: 4-6; Good: 7-9; Very good; 10-12 and Excellent: 13-15. The Kolmogorov-Smirnov test was performed to determine the normality of the data distribution and the Chi-square test to verify the hypotheses proposed, the data was processed with the SPSS 25.0 statistical package. It is concluded that there is a significant association between the degree of knowledge of the human papilloma with the age and sex of university students(AU)

Clinical research progress and implications of therapeutic vaccines for cervical cancer and precancerous lesions: a qualitative systematic review / 中华肿瘤杂志

Objective: To systematically summarize and analyze the clinical research progress of therapeutic vaccines for cervical cancer or precancerous lesions. Methods: English databases (PubMed, Embase, Web of Science, Cochrane library, Proquest, and ClinicalTrails.gov) and Chinese databases (SinoMed, CNKI, WanFang, and VIP Database) were systematically searched to collect literature on therapeutic vaccines for cervical cancer or precancerous lesions from inception to February 18, 2021. After screening, we evaluated the risk of bias of included studies, and combed the basic information of the literature, research designs, information of vaccines, study patients, outcome indicators and so on, qualitatively summarized the clinical research progress. Results: A total of 71 studies were included in this systematic review, including 14 random controlled trials, 15 quasi-random controlled trials, 4 cohort studies, 1 case-control study, 34 case series studies and 3 case reports. The study patients included women aged 15~79 with cervical cancer or precancerous lesions in 18 countries from 1989 to 2021. On the one hand, there were 40 studies on therapeutic vaccines for cervical precancerous lesions (22 867 participants), involving 21 kinds of vaccines in 6 categories. Results showed 3 marketed vaccines (Cervarix, Gardasil, Gardasil 9) as adjuvant immunotherapies were significant effective in preventing the recurrence of precancerous lesions compared with the conization only. In addition, MVA E2 vaccine had been in phase Ⅲ clinical trials as a specific therapeutic vaccine, with relative literature showing it could eliminate most high-grade precancerous lesions. Therapeutic vaccines for precancerous lesions all showed good safety. On the other hand, there were 31 studies on therapeutic vaccines for cervical cancer (781 participants), involving 19 kinds of vaccines in 7categories, with none had been marketed. 25 studies were with no control group, showing the vaccines could effectively eliminate solid tumors, prevent recurrence, and prolong the median survival time. However, the vaccines effectiveness couldn't be statistically calculated due to the lack of a control group. As for the safety of therapeutic vaccines for cervical cancer, 9 studies showed that patients experienced serious adverse events after treatments, where 7 studies reported that serious adverse events occurred in patients couldn't be ruled out as the results of therapeutic vaccines. Conclusions: The literature review shows that the literature evidence for the therapeutic vaccines for cervical precancerous lesions is relatively mature compared with the therapeutic vaccines for cervical cancer. The four kinds of vaccines on the market are all therapeutic vaccines for precancerous lesions, but they are generally used as vaginal infection treatments or adjuvant immunotherapies for cervical precancerous lesions, not used for the specific treatments of cervical precancerous lesions. Other specific therapeutic vaccines are in the early stage of clinical trials, mainly phase Ⅰ/Ⅱ clinical trials with small sample size. The effectiveness and safety data are limited, and further research is still needed.

Environmental factors associated with human papillomavirus vaccine coverage in adolescents: 2016-2020 analysis / Fatores ambientais associados à cobertura da vacina contra o papilomavírus humano em adolescentes: análise de 2016 a 2020 / Factores ambientales asociados con la cobertura de la vacuna contra el virus del papiloma humano en adolescentes: análisis de 2016 a 2020

Abstract Objective: to analyze the association between the factors of the social environment and the coverage rates of the human papillomavirus (HPV) vaccine in adolescents, in the State of Minas Gerais, Brazil. Method: this is an epidemiological, ecological study, with panel and trend analysis from 2016 to 2020. The population consisted of adolescents aged 9 to 13 years. The environmental variables were coverage rates, the municipal index of human development, income, education, and longevity; and the rate of violence. The Prais-Winsten autoregression and the panel regression model were used, in addition to the estimate of the mean annual percentage variation. Results: the vaccination coverage rates are below the goals recommended by the Ministry of Health for all regions analyzed. Moreover, these rates are associated with factors related to the application of the first dose and to aspects inherent to the social environment, such as the rate of violence. Conclusion: our findings showed that, although tenuous, aspects of the environment, in addition to individual characteristics, provide relevant information to understand the occurrence of health outcomes, since this vaccination campaign presents a strong influence of the environment and age as factors associated with the low rates.

Resumo Objetivo: analisar a associação entre os fatores do ambiente social e as taxas de cobertura da vacina contra o papilomavírus humano (HPV) nos adolescentes do estado de Minas Gerais. Método: estudo epidemiológico, ecológico, com análise em painel e de tendência, no período de 2016 a 2020. A população foi composta por adolescentes de 9 a 13 anos. As variáveis ambientais foram as taxas de cobertura; o índice de desenvolvimento humano municipal, de renda, de educação e de longevidade; e a taxa de violência. Utilizou-se o modelo autorregressivo de Prais-Winsten, o cálculo da variação percentual média anual e a regressão em painel. Resultados: as taxas de cobertura da vacina em todas as regiões analisadas estão abaixo das metas preconizadas pelo Ministério da Saúde. Ademais, tais taxas estão associadas aos fatores relacionados à aplicação da primeira dose e a aspectos inerentes ao ambiente social, como a taxa de violência. Conclusão: as evidências encontradas demonstraram que, embora tênues, aspectos do ambiente, além das características individuais, fornecem informações relevantes para compreensão da ocorrência dos desfechos de saúde, uma vez que para essa vacina temos a forte influência do ambiente e da idade como fatores associados à baixa taxa de vacinação.

Resumen Objetivo: analizar la asociación entre los factores del entorno social y las tasas de cobertura de la vacuna contra el virus del papiloma humano (VPH) en los adolescentes del estado de Minas Gerais. Método: estudio epidemiológico, ecológico, con análisis de panel y de tendencia, en el período de 2016 a 2020. La población estaba compuesta por adolescentes de 9 a 13 años. Las variables ambientales fueron las tasas de cobertura; el índice de desarrollo humano municipal, la renta, la educación y la longevidad, y la tasa de violencia. Se utilizó el modelo autorregresivo de Prais-Winsten, el cálculo de la variación porcentual media anual y la regresión en panel. Resultados: las tasas de cobertura de la vacuna en todas las regiones analizadas están por debajo de los objetivos recomendados por el Ministerio de Salud. Además, estas tasas están asociadas a los factores relacionados con la aplicación de la primera dosis y a aspectos inherentes al entorno social, como la tasa de violencia. Conclusión: las evidencias encontradas demostraron que, aunque tenues, aspectos del entorno, además de las características individuales, proporcionan informaciones relevantes para comprensión de la ocurrencia de los resultados de salud, una vez que para esa vacuna tenemos la fuerte influencia del entorno y de la edad como factores asociados a la baja tasa de vacunación.

Vaccination against human papillomavirus in Brazilian schoolchildren: National Survey of School Health, 2019 / Vacinação contra o papilomavírus humano em escolares brasileiros: Pesquisa Nacional de Saúde do Escolar, 2019 / Vacunación contra el virus del papiloma humano en escolares brasileños: Encuesta Nacional de Salud del Escolar, 2019

Abstract Objective: to analyze the prevalence of schoolchildren vaccinated against human papillomavirus (HPV) and the reasons related to non-vaccination. Method: cross-sectional study, with data from the 2019 National Survey of School Health. The sample consisted of 160,721 students aged 13 to 17 years. The prevalence and confidence intervals (95%CI) of vaccinated adolescents were estimated according to location, sex, and administrative dependence of the school. The differences between the strata were evaluated with the Chi-square test. Adjusted prevalence ratios (aPR) and 95%CI were estimated with the Poisson regression model. Results: most of the students were vaccinated (62.9%), and the prevalence of girls (76.1%) was higher than that of boys (49.1%). The most prevalent reason for not vaccinating was "did not know they had to take" (46.8%), with the highest aPR in public schoolchildren in Brazil (1.6; 95%CI 1.5;1.7), from the Northeast region (1.2; 95%CI 1.1;1.2), and in students from private schools in the Northeast regions (1.1; 95%CI 1.1;1.2) and North (1.3; 95%CI 1.2;1.4). Conclusion: one out of every two Brazilian schoolchildren was vaccinated against HPV. Misinformation was a recurring reason for non-vaccination. The North and Northeast regions had the highest prevalence of non-vaccinated people, observed mainly in adolescents from public schools.

Resumo Objetivo: analisar a prevalência de escolares vacinados contra o papilomavírus humano (HPV) e os motivos relacionados à não vacinação. Método: estudo transversal, com dados da Pesquisa Nacional de Saúde do Escolar de 2019. A amostra foi composta por 160.721 estudantes de 13 a 17 anos. Foram estimadas as prevalências e intervalos de confiança (IC95%) de adolescentes vacinados segundo localização, sexo e dependência administrativa da escola. Avaliaram-se as diferenças entre os estratos pelo teste Qui-quadrado. Estimaram-se as razões de prevalência ajustadas (RPa) e os IC95% pelo modelo de regressão de Poisson. Resultados: a maioria dos escolares foram vacinados (62,9%), sendo a prevalência de meninas (76,1%) superior à de meninos (49,1%). O motivo mais prevalente foi "não sabia que tinha que tomar" (46,8%), sendo as RPa mais elevadas em escolares de escolas públicas do Brasil (1,6; IC95% 1,5;1,7), da região Nordeste (1,2; IC95% 1,1;1,2) e em estudantes de escolas privadas das regiões Nordeste (1,1; IC95% 1,1;1,2) e Norte (1,3; IC95% 1,2;1,4). Conclusão: um a cada dois escolares brasileiros foi vacinado contra o HPV. A desinformação foi um motivo frequente para a não vacinação. As regiões Norte e Nordeste apresentaram as maiores prevalências de não vacinados, observadas principalmente em adolescentes de escolas públicas.

Resumen Objetivo: analizar la prevalencia de escolares vacunados contra el virus del papiloma humano (VPH) y las razones relacionadas con la no vacunación. Método: estudio transversal, con datos de la Encuesta Nacional de Salud del Escolar de 2019. La muestra estuvo compuesta por 160, 721 estudiantes de 13 a 17 años. Se estimaron las prevalencias e intervalos de confianza (IC95%) de adolescentes vacunados según ubicación, sexo y dependencia administrativa de la escuela. Las diferencias entre estratos se evaluaron mediante la prueba de Chi-cuadrado. Se estimaron las razones de prevalencia ajustadas (RPa) y los IC95% por el modelo de regresión de Poisson. Resultados: la mayoría de los escolares fueron vacunados (62,9%), siendo la prevalencia de niñas (76,1%) superior a la de los niños (49,1%). La razón más prevalente fue "no sabía que tenía que tomar" (46,8%), siendo las RPa más elevadas en escolares de escuelas públicas de Brasil (1,6; IC95% 1,5; 1,7), de la región Nordeste (1,2; IC95% 1,1; 1,2) y en estudiantes de escuelas privadas de las regiones de Nordeste (1,1; IC95% 1,1; 1,2) y Norte (1,3; IC95% 1,2; 1,4). Conclusión: uno de cada dos escolares brasileños ha sido vacunado contra el VPH. La desinformación fue una razón frecuente para la no vacunación. Las regiones Norte y Nordeste presentaron las mayores prevalencias de no vacunados, observadas principalmente en adolescentes de escuelas públicas.

Construção e validação de jogo educativo sobre a infecção pelo papilomavírus humano / Elaboración y validación de juego educativo sobre la infección por el virus del papiloma humano / Construction and validation of a serious game about human papillomavirus infection

Resumo Objetivo Descrever o processo de construção e validação de um jogo educativo para a prevenção da infecção causada pelo papilomavírus humano. Métodos Estudo metodológico que seguiu as etapas: conceituação, pré-produção, prototipagem, produção e avaliação de especialistas. Para a conceituação e pré-produção desenvolveu-se uma revisão integrativa, que gerou demandas de conhecimento, categorizadas e usadas na produção do protótipo. Na avaliação de especialistas, participaram 13 para análise do conteúdo e sete para design, que responderam instrumentos distintos. Os dados foram analisados quanto ao escore do Suitability Assessment of Materials e Índice de Validade de Conteúdo. Resultados Desenvolveu-se um jogo educativo baseado nas lacunas de conhecimento da população identificadas na literatura, denominado roleta digital. Os especialistas de conteúdo consideraram que a tecnologia desenvolvida possui potencial para a educação em saúde e prevenção das formas de adoecimento pelo papilomavírus humano. Na avaliação da aparência, os especialistas de design consideraram satisfatórios a compreensibilidade e qualidade da interface. Conclusão A roleta digital apresentou evidências de validade de conteúdo satisfatórias. As recomendações dos especialistas aprimoraram o conteúdo e aparência, possibilitando a mediação das atividades educativas.

Resumen Objetivo Describir el proceso de elaboración y validación de un juego educativo para la prevención de la infección causada por el virus del papiloma humano Métodos Estudio metodológico que siguió las siguientes etapas: conceptualización, preproducción, creación de prototipo, producción y evaluación de especialistas. Para la conceptualización y preproducción, se llevó a cabo una revisión integradora que generó demandas de conocimiento, que fueron categorizadas y utilizadas en la producción del prototipo. En la evaluación de especialistas, participaron 13 personas para el análisis de contenido y siete para el diseño, que respondieron distintos instrumentos. Los datos fueron analizados respecto a la puntuación del Suitability Assessment of Materials y del Índice de Validez de Contenido. Resultados Se desarrolló un juego educativo denominado ruleta digital, basado en los vacíos de conocimiento de la población identificados en la literatura. Los especialistas de contenido consideraron que la tecnología desarrollada posee potencial para la educación para la salud y la prevención de formas de contraer el virus del papiloma humano. En la evaluación de la apariencia, los especialistas en diseño consideraron satisfactorias la comprensibilidad y calidad de la interfaz. Conclusión La ruleta digital presentó evidencias de validez de contenido satisfactorias. Las recomendaciones de los especialistas mejoraron el contenido y la apariencia, lo que permitió la mediación de las actividades educativas.

Abstract Objective To describe the process of construction and validation of a serious game for the prevention of infection caused by human papillomavirus. Methods This is a methodological study that followed the steps: conceptualization, pre-production, prototyping, production and expert assessment. For conceptualization and pre-production, an integrative review was developed, which generated demands for knowledge, categorized and used in the prototype production. In an expert assessment, 13 participated for content analysis and seven for design, who answered different instruments. Data were analyzed for the score of Suitability Assessment of Materials and Content Validity Index. Results A serious game was developed based on gaps in population's knowledge identified in the literature, called electronic roulette. Content experts considered that the technology developed has potential for health education and prevention of forms of illness caused by the human papillomavirus. For assessing appearance, design experts found the understandability and quality of the interface satisfactory. Conclusion Electronic roulette presented satisfactory evidence of content validity. The recommendations of the experts improved the content and appearance, enabling the mediation of educational activities.