WHAT'S NEW THIS THURSDAY: DISEASE ERADICATION/ THREE ON HPV VACCINATION

Wednesday, 14th of November 2012

• WHAT'S NEW: DISEASE ERADICATION/HPV VACCINATION
• TOP HITS ON DISEASE ERADICATION

Dear All,

Since starting these updates in 2007, I have posted 101 items on disease eradication. These have gotten just over 33,000 hits from you, my readers. I list below those with over 1000 hits each. To access any item, type one or more words from the title into the search engine in the upper right hand corner of the page, next to the binoculars.

For those already familiar with the technical literature, start with the last item listed, ‘disease eradication and happiness.’

Good reading.

BD

• THREE ON HPV VACCINATION
  
• UNIVERSAL HPV VACCINATION FOR GIRLS IN UGANDA

Universal routine HPV vaccination for young girls in Uganda: a review of opportunities and potential obstacles.

Banura C, Mirembe FM, Katahoire AR, Namujju PB, Mbidde EK.

Infect Agent Cancer.  2012 Sep 5;7(1):24. [Epub ahead of print]

Abstract below; full text is at http://www.infectagentscancer.com/content/pdf/1750-9378-7-24.pdf

ABSTRACT: This article reviews the existing realities in Uganda to identify opportunities and potential obstacles of providing universal routine HPV vaccination to young adolescent girls. Cervical cancer is a public health priority in Uganda where it contributes to about 50--60% of all female malignancies. It is associated with a dismal 5-year relative survival of approximately 20%. With adequate financial resources, primary prevention through vaccination is feasible using existing education and health infrastructure. Cost-effectiveness studies show that at a cost of US$2 per dose, the current vaccines would be cost effective. With optimal (>=70%) coverage of the target population, the lifetime risk of cervical cancer could be reduced by >50%. Uganda fulfils 4 out of the 5 criteria set by the WHO for the introduction of routine HPV vaccination to young adolescent girls. The existing political commitment, community support for immunization and the favorable laws and policy environment all provide an opportunity that should not be missed to introduce this much needed vaccine to the young adolescent girls. However, sustainable financing by the government without external assistances remains a major obstacle. Also, the existing health delivery systems would require strengthening to cope with the delivery of HPV vaccine to a population that is normally not targeted for routine vaccination. Given the high incidence of cervical cancer and in the absence of a national screening program, universal HPV vaccination of Ugandan adolescent girls is critical for cervical cancer prevention.

• HPV PREVALENCE IN AUSTRALIA POST-VACCINATIONExpand+Journal of InfectiousDiseasesjid.oxfordjournals.org

J Infect Dis. (2012) doi: 10.1093/infdis/jis590

First published online: October 19, 2012

Fall in Human Papillomavirus Prevalence Following a National Vaccination Program

1.    Sepehr N. Tabrizi1,2,3,4,

2.    Julia M. L. Brotherton5,8,

3.    John M. Kaldor9,

4.    S. Rachel Skinner8,

5.    Eleanor Cummins4,

6.    Bette Liu9,

7.    Deborah Bateson10,

8.    Kathleen McNamee6,7,

9.    Maria Garefalakis11 and

10. Suzanne M. Garland1,2,3,4

+ Author Affiliations

1.    ¹Regional World Health Organization Human Papillomavirus Laboratory Network, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Victoria, Australia

2.    ²Department of Obstetrics and Gynecology, University of Melbourne, Australia

3.    ³Department of Microbiology

4.    ⁴Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia

5.    ⁵Registries, Victorian Cytology Service, East Melbourne, Australia

6.    ⁶Family Planning Victoria, Box Hill

7.    ⁷Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia

8.    ⁸Sydney University Discipline of Pediatrics and Child Health, Children's Hospital Westmead, Australia

9.    ⁹The Kirby Institute, University of New South Wales, Darlinghurst

10. ¹⁰Family Planning New South Wales, Ashfield

11. ¹¹Family Planning Western Australia, Northbridge, Western Australia

1.    Correspondence: Sepehr N. Tabrizi, PhD, Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Locked Bag 300, Parkville, Victoria 3052, Australia (sepehr.tabrizi@thewomens.org.au).

Abstract below; full text is athttp://jid.oxfordjournals.org/content/early/2012/10/24/infdis.jis590.long

Background. In April 2007, Australia became the first country to introduce a national government-funded human papillomavirus (HPV) vaccination program. We evaluated the program's impact on genotype-specific HPV infection prevalence through a repeat survey of women attending clinical services.

Methods. HPV genoprevalence in women aged 18–24 years attending family planning clinics in the prevaccine period (2005–2007) was compared with prevalence among women of the same age group in the postvaccine period (2010–2011). The same recruitment and testing strategies were utilized for both sets of samples, and comparisons were adjusted for potentially confounding variables.

Results. The prevalence of vaccine HPV genotypes (6, 11, 16, and 18) was significantly lower in the postvaccine sample than in the prevaccine sample (6.7% vs 28.7%; P < .001), with lower prevalence observed in both vaccinated and unvaccinated women compared with the prevaccine population (5.0% [adjusted odds ratio, 0.11; 95% confidence interval, 0.06–0.21] and 15.8% [adjusted odds ratio, 0.42; 95% confidence interval, 0.19–0.93], respectively). A slightly lower prevalence of nonvaccine oncogenic HPV genotypes was also found in vaccinated women (30.8% vs 37.6%; adjusted odds ratio, 0.68; 95% confidence interval, 0.46–0.99).

Conclusions. Four years after the commencement of the Australian HPV vaccination program, a substantial decrease in vaccine-targeted genotypes is evident and should, in time, translate into reductions in HPV-related lesions.

An updated file was supplied to correctly reflect author Julia M. L. Brotherton's affiliations.

• SEXUAL ACTIVITY–RELATED OUTCOMES AFTER HUMAN PAPILLOMAVIRUS VACCINATION OF 11- TO 12-YEAR-OLDS

1.   Robert A. Bednarczyk, PhD^a,^b,

2.   Robert Davis, MD, MPH^a,

3.   Kevin Ault, MD^c,

4.   Walter Orenstein, MD^c,^d, and

5.   Saad B. Omer, MBBS, PhD, MPH^a,^b,^c,^d 

+ Author Affiliations

1.    ^aCenter for Health Research-Southeast, Kaiser Permanente, Atlanta, Georgia; and

2.    ^bRollins School of Public Health,

3.    ^cSchool of Medicine, and

4.    ^dEmory Vaccine Center, Emory University, Atlanta, Georgia

From Pediatrics

Abstract below; full text is athttp://pediatrics.aappublications.org/content/early/2012/10/10/peds.2012-1516.long

OBJECTIVE: Previous surveys on hypothesized sexual activity changes after human papillomavirus (HPV) vaccination may be subject to self-response biases. To date, no studies measured clinical markers of sexual activity after HPV vaccination. This study evaluated sexual activity–related clinical outcomes after adolescent vaccination.

METHODS: We conducted a retrospective cohort study utilizing longitudinal electronic data from a large managed care organization. Girls enrolled in the managed care organization, aged 11 through 12 years between July 2006 and December 2007, were classified by adolescent vaccine (HPV; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed; quadrivalent meningococcal conjugate) receipt. Outcomes (pregnancy/sexually transmitted infection testing or diagnosis; contraceptive counseling) were assessed through December 31, 2010, providing up to 3 years of follow-up. Incidence rate ratios comparing vaccination categories were estimated with multivariate Poisson regression, adjusting for health care–seeking behavior and demographic characteristics.

RESULTS: The cohort included 1398 girls (493 HPV vaccine–exposed; 905 HPV vaccine–unexposed). Risk of the composite outcome (any pregnancy/sexually transmitted infection testing or diagnosis or contraceptive counseling) was not significantly elevated in HPV vaccine–exposed girls relative to HPV vaccine–unexposed girls (adjusted incidence rate ratio: 1.29, 95% confidence interval [CI]: 0.92 to1.80; incidence rate difference: 1.6/100 person-years; 95% CI: −0.03 to 3.24). Incidence rate difference for Chlamydia infection (0.06/100 person-years [95% CI: −0.30 to 0.18]) and pregnancy diagnoses (0.07/100 person-years [95% CI: −0.20 to 0.35]), indicating little clinically meaningful absolute risk differences.

CONCLUSIONS: HPV vaccination in the recommended ages was not associated with increased sexual activity–related outcome rates.