Background: Worldwide efforts have been made by some countries to offer HPV vaccination since its introduction in 2006. Population effectiveness of HPV vaccines is presently an active area of research. We review available evidence on the effectiveness of HPV vaccine uptake among female adolescents to prevent HPV infection. Methods: A comprehensive search of published and grey literature was conducted in several electronic databases using a pre-defined search strategy related to HPV prevalence following vaccination. The database searches were complemented by hand-searches of reference lists of eligible studies. Data were extracted onto a purpose-designed data extraction form, pooled in a meta-analysis and stratified by continent considering vaccine type, cross protective and (high/low) risk HPV types as subgroups. Results: Our search yielded 1680 studies, of which thirteen met with our inclusion criteria (8332 vaccinated women aged 12 to 34 years from across the world). The pooled HPV (comprising types 6, 11, 16 and 18) prevalence among vaccinated female adolescents was 7% (95% Confidence Interval (CI): 5% to 9%, 13 studies, n=8,332). The 13 studies were conducted across 3 continents: HPV prevalence for North America was 5% (95% CI: 3% to 7%, 9 studies, n=5781, age range =13 to 34); Europe, 14% (95% CI: 9% to 18%, 3 studies, n=2213, age range =13 to 29) and Australia 5% (95% CI: 3% to 8%, 1 study, n=5781, age range=13 to 34). Of the studies which reported the effect of vaccination on other non-vaccine HPV type prevalence (known as cross protective types) HPV (31, 33, 45, 51 & 58), the overall pooled cross protective HPV prevalence was 9% (95% CI: 6% to 12%, 4 studies, n=3081 age range=13 to 29), by continent North America had 14% (95% CI: 12 to 17%, 1 study, n=753 age range=14 to 24), Europe 7% (95% CI: 6 to 8%, 2 studies, n=1990, age range=13 to 29) and Australia with 8% (95% CI: 5% to 11%, 1 study, n=338 age range=18 to 26). Conclusion: This study showed an HPV prevalence of 7% in women vaccinated against HPV types 6,11,16 and 18, which represents a substantial difference to the 22% HPV prevalence in non-vaccinated women. There was no statistically significant difference between HPV prevalence across the continents. There is however, still a dearth of information on vaccinated women and HPV prevalence, highlighting the need for further studies in this area. Strengths and limitation of this review • The review comprehensively searched multiple databases and bibliographies. We had no language restrictions. • We were stringent in the selection of studies as far as vaccination status was concerned. Studies considering HPV prevalence in unvaccinated women were excluded. • A variety of methods was utilised in collecting data across the studies. However, some of the study participants were not representative of the general population. Caution therefore, needs to be considered when using these results to make inferences or conclusions about prevalence of certain populations.

Objective: To characterize the cervicovaginal microbiota of HPV-positive and HPV-negative asymptomatic Peruvian women, by identifying the presence of 13 representative bacteria genus. Results: A total of 100 HPV-positive and 100 HPV-negative women were matched by age for comparison of microbiota. The following bacteria were more frequently identified in HPV-positive patients compared to HPV-negative: Eubacterium (68 vs 32%), Actinobacteria (46 vs 33%), Fusobacterium (11 vs 6%) and Bacteroides (20 vs 13%). A comparison between high-risk and low-risk genotypes was performed and differences were found in the detection of Actinobacteria (50 vs 33.33%), Bifidobacterium (50 vs 20.83%) and Enterococcus (50 vs 29.17%). / Revisión por pares

Though vaccine uptake and public support have risen since the release of the first HPV vaccines, the United States has far lower initiation and completion rates for the HPV vaccine series in comparison to other vaccines indicated for youth. Disparities are even greater in the Appalachian regions. Understanding factors contributing to these discrepancies is vital to improving vaccine rates in Appalachia. A comprehensive literature search identified all articles pertaining to HPV vaccination in children and adolescents living in Appalachia. The final 15 articles were included in a systematic review of the topic.

Background: Human papillomavirus (HPV) infections are the most common sexually transmitted infections in the world today. HPV has been identified as the cause of both cancer and genital warts. A vaccine to prevent select types of HPV infection was developed and approved for males and females ages 9 to 26. This vaccine has not been universally accepted by healthcare providers, parents, or the public and has lower vaccination coverage rates than other recommended vaccines for the same age group. Multiple studies addressing the knowledge, perceptions, and beliefs of providers and parents regarding the vaccine have taken place. Only a few studies with the nursing profession are found in the literature and they do not look at the vaccine in regards to males. Nurses are seen as one of the most trustworthy of professions. What nurses know, perceive and believe can impact both patients and those they come in contact with on an informal basis. Objective: The purpose of this study is to determine knowledge, beliefs, and perceptions of registered nurses about the human papillomavirus and associated vaccination for males. Methodology: This study took place in February of 2013 and used a descriptive correlational design with a cross-sectional survey. The survey was administered online to alumni of the University of Central Florida (UCF) College of Nursing, members of the Theta Epsilon chapter of Sigma Theta Tau International Honor Society, and current graduate nursing students and faculty of UCF College of Nursing. There were one hundred and twelve Registered Nurses that participated in the study. Findings: Knowledge of HPV varied among respondents. The vast majority knew that HPV was a common sexually transmitted infection however less were knowledgeable on specific iii information about the vaccine. Less than eighty percent of study participants knew that the vaccine was available for both males and females. Close to ninety percent of respondents agreed that vaccinating males would be important to protect their future partners from complications associated with HPV, such as genital warts and cervical cancer, and to protect themselves from future complications, such as genital warts and cancers. Participants with doctoral degrees possessed a significantly more favorable attitude (p<0.001) towards vaccine use in males than those with a bachelors degree. Conclusions: Nurses in this study were knowledgeable about specific HPV information but were less knowledgeable about the extent of infection seen in males or the availability of the vaccine for males. This study found inaccuracies and lack of knowledge among Registered Nurses that demonstrates the need for education about HPV and the associated vaccine. While the attitudes of the respondents reflect favorably toward the vaccine, there is still a need for education among this population.

Parents acquire information about human papillomavirus (HPV) vaccines online and encounter vaccine-critical content, especially on social media, which may depress vaccine uptake. Secondary analysis in a randomized trial of a Facebook-delivered adolescent health campaign targeting mothers with posts on HPV vaccination was undertaken with the aims of (a) determining whether the pre-post-change occurred in self-reports of the mothers on HPV vaccination of their adolescent daughters; (b) describing the comments and reactions to vaccine posts; (c) exploring the relationship of campaign engagement of the mothers assessed by their comments and reactions to posts to change in the self-reports of the mothers of HPV vaccination. Mothers of daughters aged 14-17 were recruited from 34 states of the US ( = 869). A social media campaign was delivered in two Facebook private groups that differed in that 16% of posts in one were focused on indoor tanning (IT) and 16% in the other, on prescription drug misuse, assigned by randomization. In both groups, posts promoted HPV vaccination ( = 38 posts; no randomization) and vaccination for other disease (e.g., influenza, = 49). HPV and other vaccination posts covered the need for a vaccine, the number of adolescents vaccinated, how vaccines are decreasing the infection rates, and stories of positive benefits of being vaccinated or harms from not vaccinating. Guided by social cognitive theory and diffusion of innovations theory, posts were intended to increase knowledge, perceived risk, response efficacy (i.e., a relative advantage over not vaccinated daughters), and norms for vaccination. Some vaccination posts linked to stories to capitalize on identification effects in narratives, as explained in transportation theory. All mothers received the posts on vaccination (i.e., there was no randomization). Mothers completed surveys at baseline and 12- and 18-month follow-up to assess HPV vaccine uptake by self-report measures. Reactions (such as sad, angry) and comments to each HPV-related post were counted and coded. Initiation of HPV vaccination (1 dose) was reported by 63.4% of mothers at baseline, 71.3% at 12-month posttest (pre/post < 0.001), and 73.3% at 18-month posttest (pre/post < 0.001). Completion of HPV vaccination (two or three doses) was conveyed by 50.2% of mothers at baseline, 62.5% at 12-month posttest (pre/post < 0.001), and 65.9% at 18-month posttest (pre/post < 0.001). For posts on HPV vaccines, 8.1% of mothers reacted ( = 162 total), and 68.4% of posts received a reaction (63.2% like; 13.2% love, 7.9% sad). In addition, 7.6% of mothers commented ( = 122; 51 unfavorable, 68 favorable, 1 neutral), and 50.0% of these posts received a comment. There were no differences in pre-post change in vaccine status by the count of reactions or comments to HPV vaccine posts (Ps > 0.05). Baseline vaccination was associated with the valence of comments to HPV vaccine posts (7.2% of mothers whose daughters had completed the HPV series at baseline made a favorable comment but 7.6% of mothers whose daughters were unvaccinated made an unfavorable comment). Effective strategies are needed in social media to promote HPV vaccines and counter misinformation about and resistance to them. Mothers whose daughters complete the HPV vaccine course might be recruited as influencers on HPV vaccines, as they may be predisposed to talk favorably about the vaccine. Comments from mothers who have not been vaccinated should be monitored to ensure that they do not spread vaccine-critical misinformation. Study limitations included lack of randomization and control group, relatively small number of messages on HPV vaccines, long measurement intervals, inability to measure views of vaccination posts, reduced generalizability related to ethnicity and social media use, and use of self-reported vaccine status. www.clinicaltrials.gov, identifier NCT02835807.

Cervical cancer is the fourth most common cancer in women. It is caused by the hu- man papillomavirus (HPV). There are many different types of HPV, some of which are high-risk, highly associated with cancer, and low-risk. While HPV is very common— most sexually active individuals will contract some sexually transmitted HPV infec- tion in their lifetime—most infections are cleared without any complication. However, persistent infections may establish and develop into cancerous lesions. Two vaccines have been developed against the two most high-risk types, and have shown high lev- els of efficacy thus far. However, infections are still occurring and it is not clear why some individuals develop persistent infections while others do not. In this thesis, we develop a model to describe how the infection spreads within the host. We express the basic reproduction number R0, a threshold for the establishment of an infection. We solve for the diseased equilibrium, providing insight about whether an infection will persist or not. We develop a spatial model to examine how spatiality of the infec- tion process affects the establishment or clearance. Lastly, we develop a multi-type HPV model to examine whether competitive HPV types are able to coexist in the host for different levels of competition. Ultimately, this work provides groundwork for within-host modelling of HPV and can provide direction for future research. / Thesis / Master of Science (MSc) / The human papillomavirus (HPV) is a sexually transmitted infection that is known to cause cervical cancer in women along with other genital cancers. Cervical cancer is the fourth most common cancer in women, and thus researchers are looking to reduce the number of cervical cancer cases and the number of HPV infections. In order for HPV to cause cervical cancer, the infection must persist for a long time. Most individuals clear the infection without any complication; however, some individuals develop persistent infections. By using mathematical and computation models, we hope to understand why and how HPV infections spread in the host. We develop a criterion for when the infection may be able to establish in the host, and explore conditions that could lead to clearance. Understanding when and how infections will persist could inform treatment and monitoring of cervical cancer development.

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