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Background: In 2007, the Canadian federal budget provided $300 million over three years to the provinces and territories to implement publicly-funded HPV immunization programs. Current estimates indicate that HPV vaccine uptake varies significantly across Canada and is reported to be lowest in Ontario at 53%. There is a paucity of literature on the determinants of HPV vaccine uptake in the Canadian context, therefore further research is needed. Objectives: To describe the patterns of HPV vaccine non-uptake across health units in Ontario, and identify the individual- and health unit (ecologic)-level factors that influenced HPV immunization decision-making between 2007 and 2011. Methods: The study linked administrative health and immunization databases to identify a retrospective population-based cohort of 144,047 girls eligible for Ontario's school-based HPV immunization program between 2007 and 2011. In this study a girl was considered vaccinated if she received at least 1 dose, otherwise she was considered unvaccinated. Ecologic or health unit-level factors that may have influenced HPV vaccine decision-making were assessed, as well as individual-level predictors including clinical characteristics and sociodemographics. A population-average model based on generalized estimating equations was used to identify determinants associated with non-uptake. Results: In all, 49.3% of girls from 21 public health units refused HPV immunization between 2007 and 2011. Non-uptake varied across health units, from 41.82% to 60.30%. In multivariate analyses, non-uptake was strongly associated with a history of autism (OR=1.60; 95% CI 1.34, 1.90) and Down's syndrome (OR=1.37; 95% CI 1.16, 1.63), refusal of mandatory and optional vaccines (OR=2.23; 95% CI 2.07, 2.4, and OR=3.96; 95% CI 3.87, 4.05, respectively), and infrequent physician visits (OR=1.45; 95% CI 1.35, 1.55). Contextual or health unit-level characteristics appeared to have a weak influence on vaccine decision-making. Conclusions: HPV immunization could lead to a lower risk of developing and dying from HPV-related cancers; however, non-uptake of this vaccine is high. Concerted efforts are needed to reduce missed opportunities during medical consultations, to refine communication strategies and activities to address the information needs of special groups, as well as to develop cross-sectoral collaborations to support the delivery of publicly-funded HPV immunization to schools across Canada. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2013-02-01 19:49:17.262

Human Papillomaviruses (HPVs) are circular double-stranded DNA (dsDNA) viruses that infect human cutaneous and mucosal tissue. Most HPV infections are benign or cause only minor pathologies. However, infection with one of the ~15 high risk types of HPV is associated with a variety of head/neck and anogenital cancers. All told, HPV infection is thought to cause ~5% of all human cancers and cause ~275,000 deaths per year. Despite causing immense morbidity and mortality, many aspects of how HPV virions successfully establish infection in host cells remain poorly characterized. Infection begins with HPV virions binding the cell surface, where they are modified by the host protease furin. The HPV virions are then endocytosed by association with an unknown entry receptor(s). After endocytosis the HPV minor capsid protein L2 acts as a chaperone to ensure that the viral genome (vDNA) traffics from endosomes to the trans-Golgi network (TGN) and eventually the nucleus, where HPV replication occurs. En route to the nucleus, the L2/vDNA complex must translocate across limiting intracellular membranes. The details of these critical processes remain poorly characterized. In this work we investigate the viral and host factors involved in the penetration of host membranes by the HPV L2/vDNA complex. First, we elucidated many of the viral and host factors necessary for furin cleavage of L2. We also demonstrate that furin cleavage mediates the homo-oligomerization and membrane insertion of L2. Finally we demonstrate that complete translocation across the limiting membrane is dependent on host cell entry into mitosis. Overall this work provides novel insight into the molecular mechanisms used by HPV virions to breach host membranes and establish infection.

Genital human papillomavirus is one of the most common sexually transmitted infections and a significant cause of morbidity and mortality worldwide, including South Africa. Adult medical male circumcision (MMC) trials in Africa have shown decrease in acquisition of Human Immunodeficiency virus and other sexually transmitted infections. In this follow-up study, swabs that were collected 21 months post-circumcision were tested for the presence of 13 high risk HPV and 24 low risk HPV, genotypes. Results show that 17.5% and 14.3% participants were infected with at least one low risk or high risk strain of HPV respectively. The most common types of high-risk HPV were type 16 (3.5%) and 18 (3.1%). These results suggest that there is an inverse association between MMC and HPV acquisition. Participants with at least one high risk strain of HPV were 4.6 times more likely to acquire HIV than participants without high-risk HPV. This was associated exclusively with high-risk HPV infection. HIV acquisition increased dramatically in men with multiple subtypes of HPV. In a second study, more HPV genotypes were detected on the inner foreskin tissue than on the outer foreskin tissue, highlighting its vulnerability to HPV. Washing of the penis, thus removing possible contaminants reduces the number of detectable HPV genotypes. This study confirmed that the uncircumcized foreskin, in particular the inner foreskin mucosa, offers a rich environment for HPV infections. This data will allow more insight into the HPV prevalence of young men in South Africa and the multi-factorial mechanisms in play with the association between medical male circumcision and decreased genital HPV prevalence.

Thesis (M Med.(Obstetrics and Gynaecology))--University of Limpopo, 2010. / STUDY RATIONALE: Cervical cancer is the most common cancer of women on the African continent and the second most common cancer of women worldwide and in South Africa ’. It has been estimated in 1997 that, among women who received no cervical screening in South Africa, 1 in 26 women were likely to develop cervical cancer . Screening will probably decrease the incidence of cervical cancer by 60% or more . There is a direct relationship between the number of women screened by Pap smears and the decreased incidence of cervical cancer. In Iceland, where more than 90% of women were screened in that time, the incidence decreased by 80%. In Norway, where only 5% of the women were screened, the incidence only decreased by 10% . In South Africa, it is estimated that Pap smears were taken in 18.8% of white women and only 2.6% of black women in 2002 . Real-world obstacles to successful cervical cancer prevention in develo- ping countries involve people more than technologies 3. This can be ma- naged by focusing on system quality management 3. The root causes of poor quality must be examined. Suba et al 3 found causes such as obso- 7 lete supplies, poorly maintained microscopes, insufficient training and suboptimal working conditions. Successful follow-up for screen-positive women has been achieved through the allocation of budgets for dedicated personnel to recontact women with positive test results 3. Human Papillomavirus (HPV) infection is known to cause cervical can- cer. Human Papillomavirus (HPV) infection is also regarded as the most common sexually transmitted infection worldwide, with an estimated life- time risk of 79% for women to contract at least one infection between the ages of 20 and 79 years . Although some men have anal or genital lesions associated with HPV 16 and 18, most men serve as vectors of oncogenic HPV. Male partners may be important contributors to their female partners’ risk of cervical cancer . The 15 HPV types, which are classified as high risk virus types, cause 95 % of all cervical cancer. The High Risk HPV Genotypes are: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82. HPV 16 and 18 together cause around 70 % of all cervical cancer ’. Squamous cell cervical cancer constitutes approximately 80% of cervical cancers . Adenocarcinoma is the second most common histological type and shows a rising incidence, even in developed countries . 8 There is geographical variation in type-specific HPV prevalence 9. HPV16 is the most common type associated with adenocarcinomas, except in Southeast-Asia, where the prevalence of HPV 18 exceeds that of HPV 16. HPV 16, 18, 35, 45and 59 are present in 96% of adenocarci- nomas of the cervix 10. A pooled analysis by Clifford et al 9 showed that the prevalence of high risk HPV types is around 18 % in sub-Saharan Africa, with HPV 16 and HPV 35 present in 8% of women. HPV 31 and HPV 33 were present in 7% of women and HPV 18 was present in 4% of women. Sub- Saharan Africa had the highest prevalence of all HPV types and Europe the lowest. The variation in prevalence of HPV 16 across regions was smaller for HPV 16 than for the other high-risk types. The next common high- risk types were HPV 33 and HPV 56 in Asia, HPV 58 in South America and HPV 31 in Europe 9. This study’s rationale was to ascertain the HPV types prevalent in pa- tients with abnormal Pap smears seen at the Gynaecological Outpatients Clinic at Dr. George Mukhari Hospital, the Gynaecological Oncology Clinic at Dr. George Mukhari Hospital, the Tshepang Clinic at Dr. George Mukhari Hospital and the Setshaba Research Centre of the University of Limpopo – Medunsa Campus in Soshanguve. 9 This study can also act as a pilot study for future studies to test the ef- fectiveness of using high risk HPV types screening as a primary screening method, instead of Pap smears, to identify patients who are at a higher risk to develop cervical cancer and who need further investigations such as Colposcopically directed biopsies.

Thèse d'exercice : Médecine. Médecine générale : Nantes : 2003. / Thèse : 2003NANT029M. Bibliogr. f. 189-199 [135 réf.].

Thèse d'exercice : Pharmacie : Université de Nantes : 2003. Mémoire DES : Biologie médicale : Université de Nantes : 2003. / Bibliogr. f.135-144.

Thèse de doctorat : Sciences de la Vie et de la Santé : Strasbourg : 2009. / Thèse soutenue sur un ensemble de travaux. Titre provenant de l'écran-titre. Bibliogr. 24 p.

Objectives To understand the acceptability of adult males, high-risk male population (MSM and bisexual men) and parents of adolescent sons and explore factors correlated with HPV vaccination acceptability Methods A systematic searching process for literatures related to men’s HPV vaccination acceptability and published from 2000 to July, 2013 in PubMed, MEDLINE, CINAHL, Cochrane Library and Google Scholar was performed. After screening based on inclusion and exclusion criteria, qualities of all eligible studies were assessed based on the modified STROBE guideline. Results Of 15 studies were included in this systematic review, 6 focused on adult males, 4 explored the high-risk males, five reported the parental acceptability. The HPV vaccination acceptability of adult males, high-risk male population and parents of adolescent sons was moderate or high in most reviewed studies. Knowledge about HPV and HPV vaccination, perceived susceptibility, perceived benefits and healthcare provider’s recommendation were positively correlated with HPV vaccination acceptability among adult males, high-risk males and parents of adolescent sons while high expense, side effects, safety, uncertain effectiveness and hassle of receiving a 3-shots series of HPV vaccination could diminish people’s vaccination interest. Conclusion HPV vaccination acceptability among adult males, high-risk males and parents of adolescent sons is moderate or high. Further HPV vaccine campaign should focus on bridging the gap between the high vaccination acceptability and the low vaccination uptake among males. / published_or_final_version / Public Health / Master / Master of Public Health