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Journal ArticleDOI

Acceptability of HPV vaccine among a national sample of gay and bisexual men.

01 Mar 2010-Sexually Transmitted Diseases (Sex Transm Dis)-Vol. 37, Iss: 3, pp 197-203

TL;DR: HPV vaccine acceptability was high among gay and bisexual men, and these findings identify potentially important beliefs and attitudes for future communication efforts about HPV and HPV vaccine among gay or bisexual men.
Abstract: Objective: Due to higher rates of human papillomavirus (HPV) infection and anal cancer among gay and bisexual men, we aimed to characterize their willingness to get HPV vaccine and identify correlates of vaccine acceptability. Methods: We surveyed a national sample of men aged 18 to 59 who self-identified as either gay (n 236) or bisexual (n 70) during January 2009. We analyzed data using multivariate logistic regression. Results: Most men had heard of HPV vaccine (73%, 224/306) and were willing to get it (74%, 225/306). HPV vaccine acceptability was higher among men who believed their doctor would recommend getting the vaccine (OR 12.87, 95% CI: 4.63‐35.79) and those who were unsure (OR 3.15, 95% CI: 1.47‐6.76), as compared to men who believed their doctor would not recommend it. Acceptability was also higher among men who reported 5 or more lifetime sexual partners (OR 3.39, 95% CI: 1.34‐8.55), perceived greater severity of HPVrelated disease (OR 1.92, 95% CI: 1.18‐3.14), perceived higher levels of HPV vaccine effectiveness (OR 1.97, 95% CI: 1.27‐3.06), or reported higher levels of anticipated regret if they did not get vaccinated and later developed an HPV infection (OR 2.39, 95% CI: 1.57‐3.61). Conclusions: HPV vaccine acceptability was high among gay and bisexual men. These findings identify potentially important beliefs and attitudes for future communication efforts about HPV and HPV vaccine among gay and bisexual men.

Content maybe subject to copyright    Report

Acceptability of HPV Vaccine Among a National Sample of Gay
and Bisexual Men
Paul L. Reiter, PHD
*,†
, Noel T. Brewer, PHD
*,†
, Annie-Laurie McRee, MPH
*
, Paul Gilbert,
MSPH
*
, and Jennifer S. Smith, PHD
*,†
*
UNC Gillings School of Global Public Health, Chapel Hill, NC
Lineberger Comprehensive Cancer Center, Chapel Hill, NC
Abstract
Objective—Due to higher rates of human papillomavirus (HPV) infection and anal cancer
among gay and bisexual men, we aimed to characterize their willingness to get HPV vaccine and
identify correlates of vaccine acceptability.
Methods—We surveyed a national sample of men aged 18 to 59 who self-identified as either gay
(n = 236) or bisexual (n = 70) during January 2009. We analyzed data using multivariate logistic
regression.
Results—Most men had heard of HPV vaccine (73%, 224/306) and were willing to get it (74%,
225/306). HPV vaccine acceptability was higher among men who believed their doctor would
recommend getting the vaccine (OR = 12.87, 95% CI: 4.63–35.79) and those who were unsure
(OR = 3.15, 95% CI: 1.47–6.76), as compared to men who believed their doctor would not
recommend it. Acceptability was also higher among men who reported 5 or more lifetime sexual
partners (OR = 3.39, 95% CI: 1.34–8.55), perceived greater severity of HPV-related disease (OR =
1.92, 95% CI: 1.18–3.14), perceived higher levels of HPV vaccine effectiveness (OR = 1.97, 95%
CI: 1.27–3.06), or reported higher levels of anticipated regret if they did not get vaccinated and
later developed an HPV infection (OR = 2.39, 95% CI: 1.57–3.61).
Conclusions—HPV vaccine acceptability was high among gay and bisexual men. These
findings identify potentially important beliefs and attitudes for future communication efforts about
HPV and HPV vaccine among gay and bisexual men.
Human papillomavirus (HPV) infection is widespread among males, with recent prevalence
estimates ranging up to 73%.
1-4
HPV-infected men face potentially severe health
consequences, although most infections resolve spontaneously. An estimated 63% of
oropharyngeal cancers, 93% of anal cancers, and 36% of penile cancers in the United States
(US) are attributable to infection with oncogenic HPV types (mainly types 16 and 18).
5
Nononcogenic HPV types (types 6 and 11) cause anogenital warts.
6
Copyright © 2010 American Sexually Transmitted Diseases Association All rights reserved.
Correspondence: Paul L. Reiter, PhD, Department of Health Behavior and Health Education, University of North Carolina Gillings
School of Global Public Health, 323D Rosenau Hall, CB 7440, Chapel Hill, NC 27599-7440. preiter@email.unc.edu..
NIH Public Access
Author Manuscript
Sex Transm Dis. Author manuscript; available in PMC 2014 May 12.
Published in final edited form as:
Sex Transm Dis. 2010 March ; 37(3): 197–203. doi:10.1097/OLQ.0b013e3181bf542c.
NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript

HPV-related disease is of particular concern for gay and bisexual men. The estimated
prevalence of anal HPV infection among gay and bisexual men is about 60% among human
immunodeficiency virus (HIV)-negative individuals and even higher among HIV-positive
individuals, perhaps over 90%.
7-9
Men who have sex with men (MSM) are also at greater
risk for anal cancer compared with the general population,
10-12
with incidence rates
increasing over the last few decades.
13
While a quadrivalent HPV vaccine is currently approved for use in females aged 9 to 26
years in the United States,
14
studies have also shown the vaccine to be efficacious in males.
Early results have shown reductions in persistent HPV infection and genital warts among
vaccinated young men, including MSM.
15-17
Although some men may not derive full
benefit due to previous exposure to HPV types in the vaccine, it may offer them important
protection against HPV vaccine types they have not been exposed to. As with females, HPV
vaccination likely offers the greatest benefit to males if administered before sexual
debut.
18,19
Several countries have licensed HPV vaccine for use in males, though the United
States is not currently one of them.
20
Austria is the only country to currently recommend
HPV vaccination for young males.
20
In the event of approval of prophylactic HPV vaccine for use among males in the United
States, it is important to examine vaccine acceptability and potential correlates such as
knowledge and beliefs. Most studies that have addressed these topics in men have included
no or very few gay and bisexual men.
21-26
The limited research conducted among gay and
bisexual men (primarily using convenience samples recruited at community events or sexual
health centers) found low levels of awareness and knowledge about HPV,
27,28
as well as
moderate interest in receiving the vaccine.
29
In this report, we aimed to characterize correlates of acceptability among a national sample
of gay and bisexual men. We examine modifiable beliefs as potential correlates of HPV
vaccine acceptability among this high-risk population, focusing on constructs from health
behavior theory and previous research on HPV vaccine among adult women, parents, and
adolescent females.
30-32
MATERIALS AND METHODS
Study Design
We interviewed men aged 18 to 59 years who were members of an existing national panel of
US households maintained by Knowledge Networks (Menlo Park, CA) in January 2009,
oversampling men who self-identified as gay or bisexual for our study. Knowledge
Networks identified prospective panel members using list-assisted, random-digit dialing.
Households containing one or more panel members receive free internet access in exchange
for panel members completing multiple internet-based surveys each month. Panel members
in households with existing computer and internet access accumulate points as they
complete surveys, which can then be redeemed for small cash payments at regular intervals.
Of 874 men invited to participate, 609 (70%) completed our cross-sectional, online
survey.
33
We report data collected from men who self-identified as either gay (n = 236) or
bisexual (n = 70), excluding 12 men who indicated that they were not heterosexual but did
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not label their sexual orientation as either gay or bisexual. The Institutional Review Board at
the University of North Carolina approved the study.
Measures
The University of North Carolina Men’s Health Survey is available online at http://
www.unc.edu/~ntbrewer/hpv.htm. We developed survey items based on our previous HPV
vaccine research involving females, parents, and healthcare providers.
31,32,34
We
cognitively tested the survey with 28 gay and bisexual men and further refined it with 8
additional men (including 5 gay and bisexual men) before the study.
The survey measured HPV vaccine acceptability using 5 items assessing how willing a
participant would be to get HPV vaccine if it were approved for use in males (α = 0.97).
Response options were “definitely not willing,” “probably not willing,” “not sure,”
“probably willing,” and “definitely willing.” We classified each participant as either “willing
to get HPV vaccine” (responded probably or definitely willing to 3 or more items) or “not
willing to get HPV vaccine.”
The survey measured HPV awareness by asking participants if they had ever heard of HPV
before the survey. We calculated an HPV knowledge score by summing correct responses to
9 individual items (each correct answer was 1 point) asked only of men who had heard of
HPV (Fig. 1). For analyses, we classified participants as “unaware of HPV” if they had
never heard of HPV, aware of HPV with “low knowledge” if they had heard of HPV but
answered 4 or less knowledge items correctly, or aware of HPV with “high knowledge” if
they had heard of HPV and answered at least 5 knowledge items correctly.
After providing informative statements about HPV and HPV vaccine, the survey assessed
awareness of the vaccine by asking participants if they had ever heard of it before the
survey. The statements informed participants that HPV is a common sexually transmitted
infection (STI), about diseases associated with HPV, and that a vaccine exists to protect girls
and young women against cervical disease. Participants indicated whether they had ever
received any doses of HPV vaccine, attempted to get HPV vaccine but were unsuccessful,
talked to a doctor about getting HPV vaccine for themselves, whether any family members
or friends had received HPV vaccine, and where they would most likely go to get HPV
vaccine (if it were approved for males). The survey also assessed whether participants
thought their healthcare providers would recommend they get the vaccine if it were
approved for males.
The survey used multi-item scales to measure perceived knowledge of HPV-related disease
(3 items, possible range = 1–4, α = 0.74), level of concern about getting HPV-related
disease (3 items, possible range = 1–4, α = 0.53), perceived severity of HPV-related disease
(3 items, possible range = 1–4, α = 0.69), and anticipated regret of not getting HPV vaccine
and later developing genital warts or an HPV infection that could lead to cancer (2 items,
possible range = 1–4, α = 0.88). HPV-related diseases addressed in the perceived
knowledge, concern, and perceived severity scales were genital warts, anal cancer, and oral
cancer. Perceived knowledge response options ranged from “nothing at all” to “quite a lot,”
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while concern, perceived severity, and anticipated regret items had response options ranging
from “not at all” to “quite a lot.”
The survey measured perceived potential barriers to obtaining HPV vaccine with a 4-item
scale (possible range = 1–5, α = 0.65) that addressed adverse effects of HPV vaccination,
cost of HPV vaccine, and difficulty in finding a health care provider with the vaccine
available for males (if approved for use). For each perceived potential barrier, response
options ranged from “not at all” to “extremely.” The survey also assessed perceived
effectiveness of the vaccine against HPV-related disease (4 items, possible range = 1–5, α =
0.94) and perceived likelihood of getting HPV-related disease (4 items, possible range = 1–
5, α = 0.85) using multi-item scales. HPV-related diseases addressed in these scales were
genital warts, anal cancer, oral cancer, and penile cancer. Response options ranged from “no
protection” to “complete protection” for effectiveness items and “no chance” to “certain I
will get (HPV-related disease)” for likelihood items.
Participants provided information on demographic variables and health behaviors (Table 1).
We defined “urban” as living in a metropolitan statistical area and “rural” as living outside
of an metropolitan statistical area.
35
The survey also collected information on reported
history of STIs and cancer (oral, anal, or penile) or lesions (anal or penile).
Data Analysis
We used logistic regression models to examine bivariate correlates of HPV vaccine
acceptability. Statistically significant bivariate predictors (P < 0.05) were entered into a
multivariate logistic regression model. We analyzed unweighted data using SPSS version
16.0 (SPSS Inc., Chicago, IL). All statistical tests were 2-tailed, using a critical α of 0.05.
RESULTS
Participant Characteristics
Most participants were non-Hispanic white (81%), less than 50 years old (60%), reported an
income of at least $60,000 (60%), employed (80%), had health insurance (86%), and lived
in an urban area (93%) (Table 1). A majority of participants were nonsmokers (72%) and
had either not received or were unsure if they had received one or more doses of hepatitis B
vaccine (56%). Most men reported that they had not initiated sex before age 16 (65%) and a
history of 5 or more sexual partners during their lifetime (89%) (median number of reported
lifetime sexual partners = 25). Seventeen percent of men reported a history of HIV infection,
32% reported a history of other STIs, and 2% indicated a history of cancer (oral, anal, or
penile) or lesions (anal or penile).
HPV and HPV Vaccine Awareness and Knowledge
Most men (79%) reported hearing of HPV before the survey, but knowledge levels about
HPV tended to be low among those who had. Men, on average, answered 49% of the 9
knowledge questions correctly (mean = 4.39, median = 4 of 9 items correct). Most
participants knew that HPV is an STI (74%) and that it is a common infection (74%) (Fig.
1). Only 58% thought HPV causes health problems for males, with even fewer knowing
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HPV can cause genital warts (46%) and cancer (anal cancer = 32%, penile cancer = 28%,
oral cancer = 25%). Knowledge items with the highest percentage of incorrect responses
concerned whether HPV causes genital herpes (33%), oral cancer (25%), or penile cancer
(24%). In terms of HPV vaccine, most men (73%) reported hearing of it before the survey.
Beliefs About HPV and HPV Vaccine
Men expressed relatively low levels of perceived knowledge about HPV-related disease
(mean = 1.80, SD = 0.63) and concern about getting HPV-related disease (mean = 1.55, SD
= 0.54), as well as moderate levels of perceived likelihood of getting HPV-related disease
(mean = 2.19, SD = 0.55). Participants generally perceived HPV-related disease to be severe
(mean = 3.32, SD = 0.66). Participants also perceived HPV vaccine to be moderately
effective in protecting against HPV-related disease (mean = 3.03, SD = 0.82), some barriers
to getting HPV vaccine if it were available for males (mean = 2.67, SD = 0.85), and high
levels of anticipated regret if they did not get vaccinated and later got an HPV infection
(mean = 3.39, SD = 0.84). While about one-third of men (34%) thought their doctor would
recommend they get HPV vaccine if it were approved for males, almost half were unsure
(48%).
HPV Vaccine Uptake and Acceptability
No men had received HPV vaccine, 3% reported talking to a doctor previously about getting
the vaccine for themselves, and 8% reported a family member or friend had been vaccinated.
Three men reported trying to get HPV vaccine but were unsuccessful in doing so, indicating
that affordability of the vaccine (n = 2) and the doctor not giving HPV vaccine to males (n =
1) prevented them from getting it. If approved for males, men indicated they would most
likely go to a primary healthcare provider’s office (78%) or gay health center (8%) to get
HPV vaccine.
Approximately 74% (225/306) of men were willing to receive HPV vaccine. Multiple
variables were associated with acceptability of HPV vaccine in bivariate analyses (Tables 1
and 2). Men who either thought or were unsure if their doctor would recommend HPV
vaccine, had received one or more doses of hepatitis B vaccine, or reported 5 or more
lifetime sexual partners were more willing to get HPV vaccine (all P < 0.05). Furthermore,
men willing to get vaccinated reported higher levels of concern about getting HPV-related
disease, perceived severity of HPV-related disease, perceived likelihood of getting HPV-
related disease, perceived effectiveness of HPV vaccine, and anticipated regret if they did
not get vaccinated and later became infected with HPV (all P < 0.05).
In multivariate analysis (Table 3), acceptability was higher among men if they either thought
(OR = 12.87, 95% CI: 4.63–35.79) or were unsure (OR = 3.15, 95% CI: 1.47–6.76) if their
doctor would recommend they get HPV vaccine compared with those who thought their
doctor would not recommend the vaccine, if made available for males. Acceptability was
also higher among those who had 5 or more lifetime sexual partners (OR = 3.39, 95% CI:
1.34–8.55), perceived HPV-related disease to be more severe (OR = 1.92, 95% CI: 1.18–
3.14), perceived HPV vaccine to be more effective (OR = 1.97, 95% CI: 1.27–3.06), or
Reiter et al.
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Citations
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TL;DR: HPV vaccine acceptability for an adolescent daughter was associated with women's beliefs about their own healthcare needs and insights can inform future health communication activities intended to increase vaccination uptake in other high-risk populations of rural Southern women.
Abstract: Background: Although cervical cancer rates in the United States are highest in Southern and rural areas, research on human papillomavirus (HPV) vaccine acceptability has focused on other geographic areas. Methods: To address this gap, we surveyed women from a rural area in North Carolina with elevated rates of cervical cancer to identify predictors of HPV vaccine acceptability for themselves and their daughters. Results: One hundred forty-six women completed questionnaires about HPV infection, cervical cancer, and HPV vaccination. The majority (62%) of respondents were African American. Most respondents intended to vaccinate an adolescent daughter against HPV. Older and African American women reported lower vaccination intentions. Higher intentions to vaccinate an adolescent daughter against HPV were associated with knowing more about HPV, believing that HPV infection and cervical cancer are both likely and have negative consequences, and believing that the HPV vaccine is effective against cervic...

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TL;DR: HPV vaccine uptake was nearly nonexistent a year after permissive national recommendations were first issued for males, and efforts to increase vaccine uptake among adolescent males should consider the important role of peer acceptance and anticipated regret.
Abstract: In 2009, the United States approved quadrivalent HPV vaccine for males 9–26 years old, but data on vaccine uptake are lacking. We determined HPV vaccine uptake among adolescent males, as well as stage of adoption and vaccine acceptability to parents and their sons. A national sample of parents of adolescent males ages 11–17 years (n = 547) and their sons (n = 421) completed online surveys during August and September 2010. Analyses used multivariate linear regression. Few sons (2%) had received any doses of HPV vaccine, and most parents and sons were unaware the vaccine can be given to males. Parents with unvaccinated sons were moderately willing to get their sons free HPV vaccine (mean = 3.37, SD = 1.21, possible range 1–5). Parents were more willing to get their sons vaccinated if they perceived higher levels of HPV vaccine effectiveness (β = 0.20) or if they anticipated higher regret about their sons not getting vaccinated and later developing an HPV infection (β = 0.32). Vaccine acceptability was also modest among unvaccinated sons (mean = 2.98, SD = 1.13, possible range 1–5). Sons were more willing to get vaccinated if they perceived higher peer acceptance of HPV vaccine (β = 0.39) or anticipated higher regret about not getting vaccinated and later developing an HPV infection (β = 0.22). HPV vaccine uptake was nearly nonexistent a year after permissive national recommendations were first issued for males. Vaccine acceptability was moderate among both parents and sons. Efforts to increase vaccine uptake among adolescent males should consider the important role of peer acceptance and anticipated regret.

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  • ...Our results are similar to previous HPV vaccine acceptability studies among males (pre-vaccine licensure) [19,21,22] and females [49,50], as well as studies examining HPV vaccine uptake among females [29,51,52]....

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Journal ArticleDOI
Peter A. Newman1, Carmen H. Logie1, Carmen H. Logie2, Nick Doukas1  +1 moreInstitutions (2)
TL;DR: Public health campaigns that promote positive HPV vaccine attitudes and awareness about HPV risk in men, and interventions to promote healthcare provider recommendation of HPV vaccination for boys and mitigate obstacles due to cost and logistical barriers may support HPV vaccine acceptability for men.
Abstract: Objective To understand rates of human papillomavirus (HPV) vaccine acceptability and factors correlated with HPV vaccine acceptability. Design Meta-analyses of cross-sectional studies. Data sources We used a comprehensive search strategy across multiple electronic databases with no date or language restrictions to locate studies that examined rates and/or correlates of HPV vaccine acceptability. Search keywords included vaccine, acceptability and all terms for HPV. Review methods We calculated mean HPV vaccine acceptability across studies. We conducted meta-analysis using a random effects model on studies reporting correlates of HPV vaccine acceptability. All studies were assessed for risk of bias. Results Of 301 identified studies, 29 were included. Across 22 studies (n=8360), weighted mean HPV vaccine acceptability=50.4 (SD 21.5) (100-point scale). Among 16 studies (n=5048) included in meta-analyses, perceived HPV vaccine benefits, anticipatory regret, partner thinks one should get vaccine and healthcare provider recommendation had medium effect sizes, and the following factors had small effect sizes on HPV vaccine acceptability: perceived HPV vaccine effectiveness, need for multiple shots, fear of needles, fear of side effects, supportive/accepting social environment, perceived risk/susceptibility to HPV, perceived HPV severity, number of lifetime sexual partners, having a current sex partner, non-receipt of hepatitis B vaccine, smoking cigarettes, history of sexually transmitted infection, HPV awareness, HPV knowledge, cost, logistical barriers, being employed and non-white ethnicity. Conclusions Public health campaigns that promote positive HPV vaccine attitudes and awareness about HPV risk in men, and interventions to promote healthcare provider recommendation of HPV vaccination for boys and mitigate obstacles due to cost and logistical barriers may support HPV vaccine acceptability for men. Future investigations employing rigorous designs, including intervention studies, are needed to support effective HPV vaccine promotion among men.

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TL;DR: Vaccination against HPV remained low in this study and willingness to vaccinate may be decreasing, and physician recommendation and education about HPV vaccine for males may be key strategies for improving vaccination.
Abstract: Objectives. We conducted a longitudinal study to examine human papillomavirus (HPV) vaccine uptake among male adolescents and to identify vaccination predictors.Methods. In fall 2010 and 2011, a national sample of parents with sons aged 11 to 17 years (n = 327) and their sons (n = 228) completed online surveys. We used logistic regression to identify predictors of HPV vaccination that occurred between baseline and follow-up.Results. Only 2% of sons had received any doses of HPV vaccine at baseline, with an increase to 8% by follow-up. About 55% of parents who had ever received a doctor’s recommendation to get their sons HPV vaccine did vaccinate between baseline and follow-up, compared with only 1% of parents without a recommendation. Fathers (odds ratio = 0.29; 95% confidence interval = 0.09, 0.80) and non-Hispanic White parents (odds ratio = 0.29; 95% confidence interval = 0.11, 0.76) were less likely to have vaccinated sons. Willingness to get sons HPV vaccine decreased from baseline to follow-up among...

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Gregory D. Zimet1, Susan L. Rosenthal1Institutions (1)
TL;DR: The attitudes of parents, young men, and HCPs toward HPV vaccination and other sexually transmitted infections (STI) appear that parents are interested in vaccinating their sons against HPV and other STI, and adolescent and adult males areinterested in receipt of HPV vaccine and other vaccines for prevention of STI.
Abstract: The quadrivalent vaccine has been shown to be safe and efficacious against HPV infection in men. It is expected, though, that male vaccination rates will remain low. Therefore this literature review examines the attitudes of parents, young men, and HCPs toward HPV vaccination and other sexually transmitted infections (STI). It appears that parents are interested in vaccinating their sons against HPV and other (STI). In addition, adolescent and adult males are interested in receipt of HPV vaccine and other vaccines for prevention of STI. Health care providers have a general preference for vaccinating females, but they indicate a willingness to recommend HPV vaccine for their male patients. This is important given the "permissive" recommendation for male HPV vaccination issued by the US Advisory Committee on Immunization Practices (ACIP). Cost effectiveness studies have shown that vaccinating males and females is less cost effective than vaccinating females alone. With low female vaccination rates, both cost effectiveness and health benefits increase. It is clear that males have poor knowledge of HPV infection, morbidity, transmission and prevention. Regardless of vaccination strategies adopted, efforts should be made to educate males about HPV and its health implications. In addition, there are more challenges to overcome before male vaccination can be successfully implemented.

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References
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Journal Article
Abstract: These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of a quadrivalent human papillomavirus (HPV) vaccine licensed by the U.S. Food and Drug Administration on June 8, 2006. This report summarizes the epidemiology of HPV and associated diseases, describes the licensed HPV vaccine, and provides recommendations for its use for vaccination among females aged 9-26 years in the United States. Genital HPV is the most common sexually transmitted infection in the United States; an estimated 6.2 million persons are newly infected every year. Although the majority of infections cause no clinical symptoms and are self-limited, persistent infection with oncogenic types can cause cervical cancer in women. HPV infection also is the cause of genital warts and is associated with other anogenital cancers. Cervical cancer rates have decreased in the United States because of widespread use of Papanicolaou testing, which can detect precancerous lesions of the cervix before they develop into cancer; nevertheless, during 2007, an estimated 11,100 new cases will be diagnosed and approximately 3,700 women will die from cervical cancer. In certain countries where cervical cancer screening is not routine, cervical cancer is a common cancer in women. The licensed HPV vaccine is composed of the HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein in yeast using recombinant DNA technology produces noninfectious virus-like particles (VLP) that resemble HPV virions. The quadrivalent HPV vaccine is a mixture of four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18 combined with an aluminum adjuvant. Clinical trials indicate that the vaccine has high efficacy in preventing persistent HPV infection, cervical cancer precursor lesions, vaginal and vulvar cancer precursor lesions, and genital warts caused by HPV types 6, 11, 16, or 18 among females who have not already been infected with the respective HPV type. No evidence exists of protection against disease caused by HPV types with which females are infected at the time of vaccination. However, females infected with one or more vaccine HPV types before vaccination would be protected against disease caused by the other vaccine HPV types. The vaccine is administered by intramuscular injection, and the recommended schedule is a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of females is 11-12 years. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13--26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.

1,497 citations


Journal ArticleDOI
Noel T. Brewer1, Karah I. Fazekas1Institutions (1)
TL;DR: HPV vaccine programs in the United States should emphasize high vaccine effectiveness, the high likelihood of HPV infection, and physicians' recommendations, and address barriers to vaccination.
Abstract: Objective. To inform future human papillomavirus (HPV) vaccination programs, we systematically reviewed studies of HPV-related beliefs and HPV vaccine acceptability, organizing the findings using health behavior theory and cervical cancer risk factors. Methods. We searched Medline, CINAHL, and PsycINFO from 1995 to January, 2007 for studies of HPV beliefs and HPV vaccine acceptability among adolescents, young adults, and parents of adolescents in the United States. Results. We identified 28 studies. Most were small, cross-sectional studies of parents and adults. Most parents reacted positively to the possibility of vaccinating their daughters against HPV. Vaccination acceptability was higher when people believed the vaccine was effective, a physician would recommend it, and HPV infection was likely. Cost and, for 6% to 12% of parents, concerns that vaccination would promote adolescent sexual behavior were barriers to vaccination. African American, Hispanic, and white respondents were equally accepting of the HPV vaccine. Parents with lower levels of education reported higher vaccine acceptability. Many studies inadequately reported on other variables associated with cervical cancer mortality. Conclusions. HPV vaccine programs in the United States should emphasize high vaccine effectiveness, the high likelihood of HPV infection, and physicians' recommendations, and address barriers to vaccination.

791 citations


Journal ArticleDOI
J. R. Daling1, N. S. Weiss1, T. G. Hislop1, C Maden2  +6 moreInstitutions (2)
TL;DR: It was found that in men, a history of receptive anal intercourse (related to homosexual behavior) was strongly associated with the occurrence of anal cancer (relative risk, 33.1; 95 percent confidence interval, 4.0 to 272.1).
Abstract: To elucidate the risk factors for anal cancer, we interviewed and obtained blood specimens from 148 persons with anal cancer and from 166 controls with colon cancer in whom these diseases were diagnosed during 1978-1985. We found that in men, a history of receptive anal intercourse (related to homosexual behavior) was strongly associated with the occurrence of anal cancer (relative risk, 33.1; 95 percent confidence interval, 4.0 to 272.1). Anal intercourse was only weakly associated with the risk of anal cancer in women (relative risk, 1.8; 95 percent confidence interval, 0.7 to 4.2). Among the subjects with squamous-cell anal cancer, 47.1 percent of homosexual men, 28.6 percent of heterosexual men, and 28.3 percent of women gave a history of genital warts, as compared with only 1 to 2 percent of controls and no patients with transitional-cell anal cancer. In patients without a history of warts, anal cancer was associated with a history of gonorrhea in heterosexual men (relative risk, 17.2; 95 percent confidence interval, 2.0 to 149.4) and with seropositivity for herpes simplex type 2 (relative risk, 4.1; 95 percent confidence interval, 1.9 to 8.8) and Chlamydia trachomatis (relative risk, 2.3; 95 percent confidence interval, 1.1 to 4.8) in women. Current cigarette smoking was a substantial risk factor in both women (relative risk, 7.7; 95 percent confidence interval, 3.5 to 17.2) and men (relative risk, 9.4; 95 percent confidence interval, 2.3 to 38.5). We conclude that homosexual behavior in men is a risk factor for anal cancer, and that squamous-cell anal cancer is also associated with a history of genital warts, an association suggesting that papillomavirus infection is a cause of anal cancer. Certain other genital infections and cigarette smoking are also associated with anal cancer.

586 citations


Journal ArticleDOI
TL;DR: HPV infection is highly prevalent in sexually active men and can be detected by use of a variety of specimens and methods, including site- or specimen-specific HPV DNA detection.
Abstract: BACKGROUND Human papillomavirus (HPV) infection is estimated to be the most common sexually transmitted infection; an estimated 62 million persons are newly infected every year in the United States There are limited data on HPV infection in heterosexual men METHODS We conducted a systematic review of the literature by searching MEDLINE using the terms "human papillomavirus," "HPV," "male," "seroprevalence," and "serology" to retrieve articles published from 1 January 1990 to 1 February 2006 We included studies that had data on population characteristics and that evaluated male genital anatomic sites or specimens for HPV DNA or included assessments of seropositivity to HPV type 6, 11, 16, or 18 in men We excluded studies that had been conducted only in children or immunocompromised persons (HIV infected, transplant recipients, or elderly) RESULTS We included a total of 40 publications on HPV DNA detection and risk factors for HPV in men; 27 evaluated multiple anatomic sites or specimens, 10 evaluated a single site or specimen, and 3 evaluated risk factors or optimal anatomic sites/specimens for HPV detection Twelve studies assessed site- or specimen-specific HPV DNA detection HPV prevalence in men was 13%-729% in studies in which multiple anatomic sites or specimens were evaluated; 15 (56%) of these studies reported > or =20% HPV prevalence HPV prevalence varied on the basis of sampling, processing methods, and the anatomic site(s) or specimen(s) sampled We included 15 publications reporting HPV seroprevalence Rates of seropositivity depended on the population, HPV type, and methods used In 9 studies that evaluated both men and women, all but 1 demonstrated that HPV seroprevalence was lower in men than in women CONCLUSION HPV infection is highly prevalent in sexually active men and can be detected by use of a variety of specimens and methods There have been few natural-history studies and no transmission studies of HPV in men The information that we have reviewed may be useful for future natural-history studies and for modeling the potential impact of a prophylactic HPV vaccine

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