BackgroundThe investigational 9-valent viruslike particle vaccine against human papillomavirus (HPV) includes the HPV types in the quadrivalent HPV (qHPV) vaccine (6, 11, 16, and 18) and five additional oncogenic types (31, 33, 45, 52, and 58). Here we present the results of a study of the efficacy and immunogenicity of the 9vHPV vaccine in women 16 to 26 years of age. MethodsWe performed a randomized, international, double-blind, phase 2b–3 study of the 9vHPV vaccine in 14,215 women. Participants received the 9vHPV vaccine or the qHPV vaccine in a series of three intramuscular injections on day 1 and at months 2 and 6. Serum was collected for analysis of antibody responses. Swabs of labial, vulvar, perineal, perianal, endocervical, and ectocervical tissue were obtained and used for HPV DNA testing, and liquid-based cytologic testing (Papanicolaou testing) was performed regularly. Tissue obtained by means of biopsy or as part of definitive therapy (including a loop electrosurgical excision procedure and c...

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A 9-Valent HPV Vaccine against Infection and Intraepithelial Neoplasia in Women

Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.

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Acog practice bulletin

http://www.hu.ufsc.br/projeto_hpv/The%20epidemiology%20of%20genital%20human%20papillomavirus%20infection.pdf

The epidemiology of genital human papillomavirus infection.

METHODS We designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).

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Effectiveness of long-acting reversible contraception.

The identification of high-risk human papillomavirus (HPV) types as a necessary cause of cervical cancer offers the prospect of effective primary prevention and the possibility of improving the efficiency of cervical screening programmes. However, for these opportunities to be realized, a more complete understanding of the natural history of HPV infection, and its relationship to the development of epithelial abnormalities of the cervix, is required. We discuss areas of uncertainty, and their possible effect on disease prevention strategies.

The natural history of cervical HPV infection: unresolved issues.

Background—We performed a study to better characterize the natural history of genital human papillomavirus (HPV) infection in a cohort of closely followed adolescent women. Methods—A cohort of 60 adolescent women was followed over a 2.2-year period, on average. A median of 41.5 self-collected vaginal and clinician-obtained cervical swabs were obtained from each subject Results—HPV was detected in 45.3% of all adequate specimens, by use of a polymerase chain reaction/reverse blot strip assay. Oncogenic—or high-risk (HR)—HPV types were detected in 38.6% of specimens, and nononcogenic—or low-risk (LR)—types were detected in 19.6% of specimens. During the entire study period, 49 of 60 subjects tested positive for HPV (cumulative prevalence, 81.7%). The most frequently detected HR types were HPV types 52, 16, and 59. Infections with multiple HPV types were common. The median duration of persistence of a specific HPV type was 168 days, and HR types were more persistent than LR types. Abnormal cervical cytological results occurred in 37% of the adolescent women and were significantly associated with HR HPV infection. Conclusions—The cumulative prevalence of HPV infection in sexually active adolescent women is extremely high, involves numerous HPV types, and frequently results in cervical dysplasia. The marked upsurge in coital activity, pregnancy, and sexually transmitted infections (STIs) among middle-adolescent women justifies specific focus on this demographic group. Adolescents (10–19 years of age) and young adults (20–24 years of age) account for >65% of all reported STIs [1]. Human papillomavirus (HPV) is an STI of particular interest, because of its high prevalence rates and causal association with cervical malignancy. Our understanding of the epidemiology of HPV infection has grown and shifted immensely during the past 2 decades. It is well understood that infection of the genital tract with HPV leads to a range of pathologic states, including asymptomatic carriage of the virus, genital warts, cervical

A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women

Mothers' influence on the timing of first sex among 14- and 15-year-olds.

Despite recommendations in the U.S. for routine HPV vaccination of adolescent girls since 2006, rates of vaccination continue to be low. This study reports vaccination uptake, factors associated with vaccine uptake and reasons for non-vaccination within a national sample of adolescent females during 2010. Using a computer administered survey of a national sample of 501 mothers of daughters 14–17 years old we assessed maternal reports of HPV vaccination as well as socio-demographical factors, maternal HPV exposures and reasons chosen for non-vaccination. Reported HPV vaccination rates were slightly over 50 % (51.1 %), with 38.3 % reporting completion of all 3 doses. Socioeconomic and demographic factors were not associated with vaccination initiation; however, Blacks and Hispanics were less likely to complete vaccination. The most common reasons for non-vaccination were concerns about vaccine safety, danger to daughter, and provider non-recommendation. Relatively poor HPV vaccine initiation and only modest 3-dose completion continues to be a major public health concern that requires continued efforts to address identified predictors and reasons for non-vaccination.

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A national study of HPV vaccination of adolescent girls: rates, predictors, and reasons for non-vaccination.

Puberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight into the timing and sequence of changes that occur in the vaginal and vulvar microbiota during puberty. The study enrolled 31 healthy, premenarcheal girls between the ages of 10 and 12 years and collected vaginal and vulvar swabs quarterly for up to 3 years. Bacterial composition was characterized by Roche 454 pyrosequencing and classification of regions V1 to V3 of 16S rRNA genes. Contrary to expectations, lactic acid bacteria, primarily Lactobacillus spp., were dominant in the microbiota of most girls well before the onset of menarche in the early to middle stages of puberty. Gardnerella vaginalis was detected at appreciable levels in approximately one-third of subjects, a notable finding considering that this organism is commonly associated with bacterial vaginosis in adults. Vulvar microbiota closely resembled vaginal microbiota but often exhibited additional taxa typically associated with skin microbiota. Our findings suggest that the vaginal microbiota of girls begin to resemble those of adults well before the onset of menarche. IMPORTANCE This study addresses longitudinal changes in vaginal and vulvar microbial communities prior to and immediately following menarche. The research is significant because microbial ecology of the vagina is an integral aspect of health, including resistance to infections. The physiologic changes of puberty and initiation of cyclic menstruation are likely to have profound effects on vaginal microbiota, but almost nothing is known about changes that normally occur during this time. Our understanding has been especially hampered by the lack of thorough characterization of microbial communities using techniques that do not rely on the cultivation of fastidious bacteria, as well as a dearth of studies on girls in the early to middle stages of puberty. This study improves our understanding of the normal development of vaginal microbiota during puberty and onset of menarche and may better inform clinical approaches to vulvovaginal care of adolescent girls.

Vaginal Microbiota of Adolescent Girls Prior to the Onset of Menarche Resemble Those of Reproductive-Age Women

OBJECTIVES: The aims of this study were to compare prevalence rates of human papillomavirus (HPV) in young women before and after HPV vaccine introduction to determine the following: (1) whether vaccine-type HPV infection decreased, (2) whether there was evidence of herd protection, and (3) whether there was evidence for type-replacement (increased prevalence of nonvaccine-type HPV).

METHODS: Young women 13 to 26 years of age who had had sexual contact were recruited from 2 primary care clinics in 2006–2007 for a prevaccination surveillance study ( N = 368, none were vaccinated) and 2009–2010 for a postvaccination surveillance study ( N = 409, 59% were vaccinated). Participants completed a questionnaire and were tested for cervicovaginal HPV DNA. HPV prevalence rates were compared in the pre- versus postsurveillance studies by using χ2 tests. Propensity score weighting was used to balance differences in covariates between the 2 surveillance studies.

RESULTS: The mean age was ∼19 years for both groups of participants and most were African American and non-Hispanic. After propensity score weighting, the prevalence rate for vaccine-type HPV decreased substantially (31.7%–13.4%, P < .0001). The decrease in vaccine-type HPV not only occurred among vaccinated (31.8%–9.9%, P < .0001) but also among unvaccinated (30.2%–15.4%, P < .0001) postsurveillance study participants. Nonvaccine-type HPV increased (60.7%–75.9%, P < .0001) for vaccinated postsurveillance study participants.

CONCLUSIONS: Four years after licensing of the quadrivalent HPV vaccine, there was a substantial decrease in vaccine-type HPV prevalence and evidence of herd protection in this community. The increase in nonvaccine-type HPV in vaccinated participants should be interpreted with caution but warrants further study.

* Abbreviations:
 CIN — : cervical intraepithelial neoplasia
 HPV — : human papillomavirus
 ICC — : invasive cervical cancer

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Marcia L. Shew

Papers

A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women

Mothers' influence on the timing of first sex among 14- and 15-year-olds.

A national study of HPV vaccination of adolescent girls: rates, predictors, and reasons for non-vaccination.

Vaginal Microbiota of Adolescent Girls Prior to the Onset of Menarche Resemble Those of Reproductive-Age Women

Vaccine-Type Human Papillomavirus and Evidence of Herd Protection After Vaccine Introduction