Syftet var att undersöka vilket av vaccinen mot Humant papillomvirus-HPV, Gardasil eller Cervarix som är att föredra, med avseende på biverkningsprofilen, det vill säga vilket av vaccinen som är mest skonsamt för kroppen. HPV-vaccinen skyddar mot HPV-typerna 16 och 18 som bland annat orsakar livmoderhalscancer. Viruset smittar via sexuell kontakt och infekterar främst celler i mukosa. Infektionsfrekvensen av HPV är likvärdig mellan män och kvinnor. Det finns högrisktyper av HPV (HPV16/18) som orsakar cancer och det finns lågrisktyper som orsakar genitala vårtor (HPV 6/11). Gardasil innehåller fyra HPV-typer (HPV6/11/16/18) och Cervarix innehåller två HPV-typer (HPV16/18). Mycket vanliga biverkningar (≥1/10) för båda vaccinen är huvudvärk, svullnad, rodnad, och smärta vid injektionsstället. Vanliga biverkningar (≥1/100 eller <1/10) är bland annat feber, illamående och klåda. Fyra artiklar valdes ut med pubmed via sökorden ”Gardasil”, ”Cervarix” och ”safety”. Studie 1 handlar om booster-dosering av bHPV/qHPV till flickor (12-13 år) som tidigare hade fått två doser av qHPV tillsammans med Twinrix (Hepatit A/B). I studie 2 jämfördes två doser bHPV med två respektive tre doser qHPV hos flickor 9-14 år, för att undersöka om vaccinen var likvärdiga eller om två doser bHPV var ett bättre val. Studie 3 och 4 var uppföljningsstudier till samma grundstudie med kvinnor från 18-45 år. Studie 3 pågick fram till månad 48 och studie 4 fram till månad 60. Studie 3 och 4 jämförde tre doser av bHPV med tre doser av qHPV avseende hur seropositiviteten förändrades över tiden. Cervarix fick lägre procentandelar i sin biverkningsprofil, vid jämförelse mot studie 1 och studie 2 (två doser av Cervarix som gavs i Studie 2). Slutsats var att båda vaccinen hade jämförbara biverkningsprofiler och var därför likvärdiga i det avseendet. Om seropositiviteten jämförs så har bHPV längre varaktighet än qHPV eller att qHPV är bättre val eftersom det även skyddar mot HPV 6 och 11. / The purpose of this diploma work project was to determine if one of the HPV-vaccines, Cervarix-bHPV or Gardasil-qHPV, has lower safety adverse events- SAE. There are more than 150 different types of human papillomavirus, which infect mucosal cells, mostly in the genital tract. The virus infects through sexual-contact, there are high-risk HPV-types such as HPV16/18, which are oncogenic and low-risk HPV-types such as HPV6/11, which cause genital warts. The goal for the world health organization-WHO is to get the HPV-vaccines to all women around the globe. Most common age for the vaccinées is 12-years. Headache, pain, erythema and swelling are very common adverse events for both of vaccines. Common adverse events are fever and nausea. In addition, Post Orthostatic Tachycardia Syndrome-POTS and Complex Regional Pain Syndrome-CRPS have been reported, mostly from Japan and Denmark. European medicines agency-EMA made a statement that the HPV-vaccines are not the cause of the POTS or CRPS (2015), because the profile of the symptoms from Japan and Denmark do not correlate with symptom profiles of POTS or CRPS. In Denmark’s case, EMA suggest that some of the cases resembles symptoms of chronic fatigue syndrome-CFS and not POTS. This diploma work project was made with the help of Pubmed, with the words “Gardasil”, “Cervarix” and “safety”. Four articles were chosen from the search.  The authors of the first article examined the effect of booster dose of bHPV or qHPV to girls age 12-13, who already had received two doses of qHPV. In the second article, two doses of bHPV were compared with two or three doses of qHPV in 9-14 year-old girls in order to determine if bHPV were equal or superior to two or three doses of qHPV. The third and fourth articles are follow-up studies of the second one, the third up to 48 months and the fourth up to 60 months. These articles were studying the sero-positivity in the vaccinated subjects over time. When comparing study one and two, the bHPV safety profiles differences were seen in the safety adverse events in both local and general or systemic adverse events. There was a difference of adverse events between (article 2) three doses of qHPV to (article 1) booster dose of qHPV. Sero-positivity showed that bHPV induced high titres of HPV 16 and 18 antibodies while qHPV vaccine also induced high amounts of HPV 16 antibodies but low amounts of HPV 18 antibodies. About 20 % of the women in qHPV-groups lost sero-positivity by month 60. bHPV and qHPV vaccines were similar regarding adverse events. The vaccines had equal types of local and systemic or general adverse events. Sero-positivity was higher in subject vaccinated with bHPV compared to qHPV, with the highest decline in sero-positivity for anti-HPV 18. The conclusions of this literature study is that the qHPV vaccine protects against low-risk and high-risk HPV-types, while the bHPV vaccine has longer duration.

Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the US, with an estimated incidence rate of 6.2 million new cases each year. Men have higher instances of certain HPV related outcomes (e.g., head/neck cancers) when compared to women, so male vaccination with the HPV vaccine is also paramount to preventing cancer. The present study examined the theory of planned behavior (TPB) as a model for predicting HPV vaccination intentions among men. Results suggest the TPB was a well-fitting model to the data, but not all aspects of the TPB model were predictive of HPV vaccination intentions. Behavioral beliefs (e.g.., the belief that vaccination will provide a beneficial outcome) were the only significant predictor of HPV vaccination intention in the next 6 months. Perceived norms, motivations to comply with norms, attitudes towards the HPV vaccine, and self-efficacy were not significant predictors of HPV vaccination intentions.

This is a critical discourse analysis research project that examines the print and television advertisements of Merck & Co.’s Human Papillomavirus (HPV) vaccine GARDASIL®. There are three commercial campaigns identified for this project: “Make the Connection/ Charm4Life,” “Tell Someone,” and “One Less/ I Choose.” Two print and two television commercials per campaign are analyzed. I used black feminist and girls studies theoretical frameworks to address how representations of race, class, “girl power,” and the cooptation of feminist language are both expressed and utilized in the marketing as a method to target consumers. I conclude with “parody/ protest” advertisements of the vaccine featuring young women demonstrating a critical consumer voice towards the marketing of the vaccine. As a result, I found that the PSAs used fear-driven messages about HPV’s link to cervical cancer beginning a year before the FDA’s approval of GARDASIL® in order to market and sell its product.

How does a drug with a limited safety and efficacy record become an international blockbuster? In June 2006 the FDA approved and recommended a new vaccine directed against 4 types of sexually transmitted human papillomavirus, associated with 70% of cervical cancer cases and 90% of genital wart cases. Branded as a "cervical cancer vaccine" Gardasil has been met with as much fanfare as controversy, and retains blockbuster status in Merck's portfolio. Sold as a cancer risk-reduction method, Gardasil carries its own risks, with startlingly low efficacy and elevated likelihood of serious adverse events (side effects). Through the lens of risk, this dissertation examines Gardasil's popularity in the face of evidence that it is neither as safe nor as effective as advertised. Through three distinct research projects, I identify (a) five sociological factors responsible for Gardasil's success on the heels of Vioxx, one of the biggest drug scandals in history; (b) how amongst healthy vaccinated girls, cervical cancer is experienced as a "risk object," yet when a young woman experiences a serious adverse event that "object of risk" and her "experience of risk" shift toward Gardasil; and (c) that Gardasil is so trusted among young women, that warnings about potential side effects from others made some girls more likely to get vaccinated and have a positive opinion on the vaccine, suggesting that Gardasil benefits from a broader cultural assumption that vaccines are inherently safe and effective. Physicians and pharmaceutical marketing also play an important role. Gardasil is a risk-reduction drug and vaccine purported to treat risk while it simultaneously creates new risk for further health problems in some consumers. This dissertation contributes to sociological literatures on pharmaceuticalization, pharmaceutical pseudoscience, the social construction of risk, research on regulatory agencies, and the sociology of medicine more broadly.

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Η πρόληψη του καρκίνου του τραχήλου της μήτρας (ΚΤΜ) αποτελεί κυρίαρχη συνιστώσα της φροντίδας υγείας των γυναικών. Απαραίτητη προϋπόθεση για την πρόληψη του συγκεκριμένου καρκίνου είναι η εκτίμηση αναγκών υγείας του γυναικείου πληθυσμού, ιδιαίτερα στην Ελλάδα. Ο ΚΤΜ είναι κακοήθη νεοπλάσματα του τραχήλου της μήτρας ή του τραχήλου της περιοχής. Το τεστ Παπανικολάου μπορεί να εντοπίσει ενδεχομένως προκαρκινικές αλλαγές. Η θεραπεία των υψηλού βαθμού αλλαγών μπορεί να εμποδίσει την ανάπτυξη του καρκίνου. Στις ανεπτυγμένες χώρες, η διαδεδομένη χρήση των προγραμμάτων προσυμπτωματικού ελέγχου του τραχήλου της μήτρας έχει μειώσει την επίπτωση της διεισδυτικής του τραχήλου της μήτρας κατά 50% ή και περισσότερο. Μετά από μελέτες που διήρκησαν μία 20ετία αποδείχθηκε ότι υπάρχει αιτιολογική σχέση μεταξύ ΚΤΜ και του Ιού Ανθρωπίνων Θηλωμάτων. Ο Ιός των Ανθρωπίνων Θηλωμάτων είναι μέλος οικογένειας ιών που είναι ικανή να μολύνει. Τα εμβόλια κατά του HPV (Gardasil και Cervarix) εμποδίζoυν τη μόλυνση από τους HPV τύπους (16 και 18) που προκαλούν το 70% του ΚΤΜ και μπορούν να οδηγήσουν και σε περαιτέρω μειώσεις. Το εμβόλιο Gardasil ( Merck & Co ) είναι ένα εμβόλιο που έχει αποδειχθεί ότι αποτρέπει ορισμένους τύπους του ιού του HPV, ειδικότερα τους τύπους 16, 18, 6, και 11. Οι HPV τύποι 16 και 18 υπολογίζεται ότι προκαλούν το 70% του ΚΤΜ και είναι υπεύθυνες και για τον καρκίνο πρωκτού , του αιδοίου , του κόλπου και του πέους. Οι τύποι 6 και 11, υπολογίζεται ότι προκαλούν το 90% των περιπτώσεων των γεννητικών κονδυλωμάτων . Το Gardasil προλαμβάνει λοιμώξεις του ιού HPV, αλλά δεν αντιμετωπίζει υπάρχουσα λοίμωξη. Ως εκ τούτου, για να είναι αποτελεσματικός ο εμβολιασμός, πρέπει να δοθεί πριν από τη λοίμωξη. Το Cervarix (GlaxoSmithKline) είναι ένα εμβόλιο κατά ορισμένων μορφών καρκίνου που προκαλεί ο HPV. Το Cervarix έχει σχεδιαστεί για την πρόληψη της λοίμωξης από τους HPV τύπους 16 και 18, που προκαλούν περίπου το 70% του ΚΤΜ. Αυτοί οι τύποι επίσης μπορεί να προκαλέσουν και κάποια άλλα είδη καρκίνων, όπως των γεννητικών οργάνων και ορισμένων στοματοφαρυγγικών καρκίνων. Επιπλέον, κάποια διασταυρούμενη αντίδραση προστασίας από στελέχη του ιού 45 και 31 έχει αποδειχθεί σε κλινικές δοκιμές με τη χρήση του Cervarix. Σκοπός της παρούσας εργασίας είναι η εκτίμηση αναγκών υγείας για την πρόληψη του ΚΤΜ στο γυναικείο πληθυσμό που διαμένει στην Πάτρα και στον Πύργο. Επιμέρους στόχοι είναι η καταγραφή της συμμετοχής των γυναικών στον εμβολιασμό κατά του ΚΤΜ και η διερεύνηση παραγόντων που επηρεάζουν τη συμμετοχή τους. Ο σχεδιασμός ολοκληρωμένου προγράμματος πρόληψης με τον εμβολιασμό κατά του ΚΤΜ είναι εφικτός και βασίζεται στην εχέμυθη σχέση ασθενούς και γιατρού. / The prevention of cervical cancer constitutes a main component of women’s health care. A necessary precondition for this prevention is the health needs assessment of the female population, especially in Greece. Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. Pap smear screening can identify potentially precancerous changes. Treatment of high grade changes can prevent the development of cancer. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more. Human papillomavirus (HPV) infection is a necessary factor in the development of almost all cases of cervical cancer. After 20 years studies, the relationship between cervical cancer and human papillomavirus (HPV) was proved. A HPV is a member of the papillomavirus family of viruses that is capable of infecting humans. HPV vaccines (Cervarix and Gardasil), which prevent infection with the HPV types (16 and 18) that cause 70% of cervical cancer, may lead to further decreases. Gardasil (Merck & Co.) is a vaccine proven to prevent certain types of human papillomavirus (HPV), specifically HPV types 16, 18, 6, and 11. HPV types 16 and 18 cause an estimated 70% of cervical cancers and are responsible for many anal, vulvar, vaginal, and penile cancer cases. HPV types 6 and 11 cause an estimated 90% of genital warts cases. Gardasil prevents HPV infections, but does not treat existing infection. Therefore, to be effective it must be given before HPV infection occurs. Cervarix is manufactured by GlaxoSmithKline. It is a vaccine against certain types of cancer-causing human papillomavirus (HPV). Cervarix is designed to prevent infection from HPV types 16 and 18 that cause about 70% of cervical cancer cases. These types also cause some other genital cancers and some oropharyngeal cancers. Additionally, some cross-reactive protection against virus strains 45 and 31 were shown in clinical trials. The purpose of this study is to assess health needs for cervical cancer prevention concerning the female population living in Patras and Pyrgos. Partial purposes are: to record women’s participation in HPV vaccines and look into the factors that affect this participation. The planning of a preventive project concerning HPV vaccines is feasible and is based on a perfect relationship and trust between patient and doctor.

Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States. Despite most common transmission, HPV immunization in adolescents remains below target rates of 80% as outlined by Healthy People 2020 Objectives. Nearly all individuals will contract HPV during their lifetime. The purpose of this project was to educate providers on successfully promoting HPV immunization in adolescents utilizing evidence-based methods. The health belief model (HBM) was the theoretical underpinning utilized to teach providers on discussions about 9vHPV immunization with parents of adolescents. The practice focused question explored whether an education program using concepts from the HBM would increase provider perception of preparedness on recommending Gardasil 9 immunization in adolescents. Convenience sampling was utilized to recruit participants. There were 9 out of 25 providers that attended the educational in service with 8 completing the continuing education evaluation tool. Participants included providers who are affiliated and hold privileges with the health care system. Survey Monkey was used to analyze the participant evaluations. All the participants found the educational information relevant to increasing their perception of preparedness on recommending Gardasil 9 immunization in adolescents. The findings suggest that providers would benefit from training on recommending HPV immunization in adolescents. Continued training would help enhance timely immunization rates that could decrease cancer rates and reduce associated healthcare cost, in turn promoting population health and positive social change.

Introduction: Juvenile onset recurrent respiratory papillomatosis (JoRRP) is the commonest benign paediatric neoplasm. There is no curative treatment, but the condition is self-limiting. Current primary treatment is aimed at symptomatic relief, comprising of serial surgical debulking of obstructive papillomas along the respiratory tract, with voice preservation. Adjuvant therapy is indicated in severe cases. Objective: A review of children with JoRRP presenting to the ENT Department at Red Cross War Memorial Children’s Hospital (RCWMCH) over 2 years. Evaluation of the pattern of disease and factors that may contribute to disease severity were reviewed. Method: Retrospective folder review of children with histologically confirmed laryngeal papillomatosis over above the time period. Results: Twenty children were included. Nine were male, 11 were female. The median age at diagnosis was 2.4 years (11 - 109 months). Presentation at < 3 years was noted in 5/7 of the most severe cases. Nine of 20 were HPV serotyped; 5 were type 11, and 4 were type 6. Eighty percent (16/20) were HIV negative; 10% (2/20) HIV positive; and 10% (2/20) were unknown. A total of 90 surgical procedures were performed; the highest number of surgeries per child was 13. Inter-surgical time was 1 to 164 weeks (median 9 weeks). Four received Gardasil vaccination as adjuvant therapy, 3 of who showed a reduction in disease severity. Conclusion: JoRRP commonly presents around the first 3 years of life. Severe cases can be life-threatening, often with multiple hospital admissions for clearance of surgical papillomata. Severe cases presented before 3 years. Gardasil vaccination as adjuvant therapy has promise. No identifiable risk factors in our review were noted. HIV co-infection and HPV type were not risk factors for severity.

This study applied the constructs of the health belief model (HBM) to assess women's knowledge and attitudes (i.e., perceived susceptibility, perceived severity, perceived benefits and perceived barriers) regarding cervical cancer, HPV, and the HPV vaccine and determine whether they predict women's intentions to receive the HPV vaccine. Women aged 18 to 26 years were surveyed from a convenience sample, and were primarily well-educated White women. Using Polytomous Universal Model (PLUM) ordinal regression, it was determined that the constructs of this model could not predict women's intentions of receiving the HPV vaccine.

Healthy People 2020 was launched in December 2010 with a target human papilloma virus (HPV) vaccination rate of 80%. As of 2014, we were well short of this goal, especially among males, for whom the HPV vaccine became recommended in 2011. An estimated 14-20% of adolescent-aged males had completed the vaccine schedule as of 2015. This is particularly problematic in northeast Tennessee, as multiple risk factors for lower vaccination rates are characteristic of the population, including being white and living in the South. Reasons to decline vaccination vary, and usually involve concerns about safety, efficacy, and necessity. Worries about sexual disinhibition from being vaccinated are often cited by opponents. Parents also perceive a lack of benefit from getting the vaccination starting at age 11 before their sons are sexually active. The media and internet are also barriers to appropriate vaccination in males, as previous research has demonstrated that media coverage is more likely to focus on political controversies instead of benefits, and is more likely to emphasize the benefits to females. Research on improving vaccine uptake on males is currently limited. Doctors who appear knowledgeable and are willing to spend time talking about the HPV vaccine for male patients may increase vaccination rates. Other interventions that may also be effective include vaccinating as part of nurse visits or through school programs. Early studies have been mixed on the effect of patient and parent education on vaccine uptake, although a 2015 review demonstrated that most practice- and community-based educational interventions have some positive effect on uptake. The purpose of this project was to improve HPV vaccine uptake among male patients in a family practice residency program through patient and parent education. After informed consent was obtained, the patients and/or their parents were given a handout produced by the CDC highlighting the benefits of vaccination for males. A chart review was done to determine vaccine coverage among males before the intervention instituted in November of 2016. The intervention was completed in August 2017, and a repeat chart review is currently ongoing to determine vaccine coverage in the post-intervention period. Data collection and analysis is ongoing at the time of abstract submission. We expect a statistically significant increase in the number of male patients who have received any doses of vaccine, and in the number who have completed the vaccine series. Future research should involve broadening the intervention to include local family medicine and pediatrician’s offices to increase vaccine uptake in these populations as well.