Thesis (M.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-05, page: 2666. Adviser: Christine Markham. Includes bibliographical references.

A new opportunity to reduce cervical cancer deaths as well as other HPV associated diseases arises from recently developed prophylactic vaccines. A large body of scientific literature concludes that the vaccines provide 100% protection against the oncogenic (high-risk) HPV types 16 and 18, which are responsible for about 70% of all cervical cancers in women. The vaccines also protect against infections with HPV 6 and 11, the cause of about 90% of genital warts (condylomataacuminata) in both males and females. South Africa is faced with uncertainties about how to implement a HPV vaccine immunisation programme aimed at the improvement of health in relation to the burden of disease caused by cervical cancer and related HPV-implicated diseases whilst struggling to provide the most basic of healthcare services in the midst of a HIV pandemic and a diminished base of key healthcare professionals. In such a context and relative to other priorities and the comparative benefits of different interventions, should, and if so why should South Africa invest in a HPV vaccine immunisation programme; likewise, if not, why not? In this research, report I will provide the main ethical and legal issues related to the implementation of a National HPV vaccine immunisation intervention programme. The research method used is a literature review of some ethical & legal issues in HPV vaccine immunisation analysing findings by way of critical thinking and moral reasoning. The outcomes of my research report suggest that South Africa is bound ethically and legally to provide HPV vaccine immunisation as an intervention to reduce the scourge of HPV infections, especially cervical cancer-based on the outcomes, I make recommendations concerning policy changes at the National level. These changes include interventions targeting the youth with an HPV vaccine immunisation programme included as one type of intervention.

Background: Human papillomavirus vaccination is newly developed in this decade. There are 2 types of vaccines. Bivalent vaccine targets on HPV types 16, 18 to prevent cervical cancer. Quadrivalent vaccine target on HPV type 6, 11, 16, 18 to prevent genital warts and cervical cancer. England has adopted a population –based HPV vaccination program. In attempt to find out the worthiness to implement the population-based vaccination program in Hong Kong, this project reviewed 15 cost-effectiveness analyses in Asian countries. Asian countries may have the similar characteristics, such as culture, sex behavior, genome, etc, that makes the result more applicable to Hong Kong. Methodology: Cost-effectiveness analysises of human papillomavirus vaccination were identified by the searching engine MEDLINE (Ovid) by using relevant keywords. All English and Chinese articles relevant to the topic were identified. Articles conducted for the cost-effectiveness of human papillomavirus vaccine in Asian countries were considered as the potential literature for the review. Result and Discussion: The searching engine identified 259 literatures, 16 of them are in Asian countries, 1 of them did not meet the criteria of quality assessment. 15 of them are included in this review. 6 different model approaches were used in the 15 articles. Results from the same countries in 2 separated articles were heterogeneous. That may probably due to the different assumption and perspectives used. Different perspectives would include different costing. Studies only including the direct cost would likely over-estimate the cost-effectiveness of the vaccine. The threshold value adopted would also affect the result. A stricter threshold value would under-estimate the cost-effectiveness. Some low-and-middle income countries has no available data on the vaccination because the vaccine is not available in the market, the data would only rely on the past literature or international data. 12 out of the 15 studies showed that the vaccination is cost-effective in the countries. Conclusion and Implication: the ICER is sensitive to the price of the vaccine, the efficacy, the duration of protection, the discount rate, the screening coverage rate, and the age of receiving vaccination, the vaccination coverage rate and the cervical cancer or genital warts incidence rate. Some studies showed that regular screening combined with vaccination program would be cost-effective. In the studies comparing the 2 types of vaccines, all the results showed that quadrivalent vaccine dominant to the bivalent vaccine. Moreover, the vaccination would decrease the cervical cancer incidence by 20% to 90%. In view of the prevalence of HPV type and the high incidence rate of genital warts. The quadrivalent vaccine is likely beneficial to Hong Kong / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Community Medicine / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

Background Human Papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. It is the leading cause of genital warts and cervical cancer, and is strongly associated with oropharyngeal and other anogenital cancers. To date, two prophylactic HPV vaccines are available, both of which have shown high efficacies in protection against vaccine-type HPV infection and HPV-associated diseases in both males and females. Despite the proven efficacies, male vaccination has not been included in any national vaccination programme worldwide. In Hong Kong, vaccine uptake remains low despite the Department of Health’s recommendation, and a routine comprehensive vaccination programme is yet to be adopted. However, very limited cost-effectiveness data are available to guide policy makers on the economic potential of implementing routine HPV vaccination, especially that of extending vaccination to males. This systematic review is among the first to evaluate the latest cost-effectiveness analyses of HPV vaccination in men and apply the synthesis to the context of Hong Kong, which will help local policy makers in their consideration of implementing a comprehensive HPV vaccination programme in Hong Kong, especially whether to extend vaccination to males. Methodology A systematic review was conducted to retrieve literatures that provide full economic evaluations of cost-effectiveness analyses of HPV vaccination programmes that included males, by searching in the MEDLINE (Ovid system) using relevant keywords. English articles that provide full economic evaluations of cost-effectiveness analyses of HPV vaccination programmes in men or in both sexes in the age group of 9-45 years were considered as potential studies for inclusion in this review. Results The literature search identified 117 studies, 107 among them failed to meet the inclusion criteria, 2 were duplicated studies, 1 did not meet the quality assessment criteria described by Drummond et al. A total of 7 studies were included in this review. All studies adopted dynamic models, except one using static model, which did not take into account the effect of herd immunity on HPV transmission. The studies measured the cost-effectiveness using different assumptions on vaccine costs, coverage, efficacies, duration of protection, costing and perspectives. Only several studies took a societal perspective in their analyses and included non-medical and indirect costs. 4 among all studies explored the cost-effectiveness of extending HPV vaccination to males, 2 only focused on female-only HPV vaccination with indirect benefits to males, and 1 only evaluated vaccination of the men who have sex with men (MSM) population. The discrepancies in different costing and outcome measures lowered the comparability of cost-effectiveness analyses. Yet, in general, the studies reported vaccine efficacies and duration of protection to significantly impact the cost-effectiveness of vaccination in both sexes. Moreover, vaccine coverage is critical to influence cost-effectiveness, for male vaccination would only be cost-effective given a female vaccine coverage of 50% or below. Conclusion and Implications Evidence from recent cost-effectiveness analyses suggested that vaccinating 12-year-olds is cost-effective. School-based immunization programmes are recommended to vaccinate the population at an early age before sexual debut for better clinical and economic benefits. Extending HPV vaccination to boys will be cost-effective when female vaccine coverage is low. Given a low vaccine uptake rate among schoolgirls in Hong Kong, policy makers should consider expanding vaccination to boys when implementing a routine immunization programme by synthesizing findings from epidemiological and economic evaluations. / published_or_final_version / Community Medicine / Master / Master of Public Health

Thesis (M. Phil.)--Hong Kong University of Science and Technology, 2003. / Includes bibliographical references (leaves 112-129). Also available in electronic version. Access restricted to campus users.

Human papillomavirus (HPV), a family of viruses with more than 40 genotypes is known to infect genital tract of males and females. High-risk HPV including genotypes 16, 18 can cause cervical cancer while low-risk HPV including genotypes 6, 11 can cause benign or low grade cervical lesions and genital warts. Considering HPV infection is the most common sexually transmitted infection worldwide, as well as in Macao, with prevalence up to 8.1%, and given that cervical cancer is the top ten most frequent female cancer which causes high burden in our health care system, it is important to have a comprehensive intervention for control HPV and cervical cancer. Since the HPV vaccine for preventing cervical cancer has been available in Macao, it is worth to know the willingness to be vaccinated among target population. Base on findings from previous studies, the parental attitudes and acceptance is the key factor of vaccination for young girls. Other potential factors, such as the HPV knowledge, vaccine safety and efficacy, cost, the age of daughter and the physician’s attitudes, may also affect parental acceptance. Given that no previous study on this topic has been conducted, this study is aimed to understand the knowledge, attitudes and acceptability of HPV vaccination, and to explore and identify the affecting factors for acceptance among school girls and their parents. A school-based simple cluster random sampling method was used. Data was collected by anonymous self-administrated questionnaires among 574 school girls aged at 12-22 and 702 parents aged at 30-65. About 47% of the school girls had heard of HPV and 88.3% had heard of HPV vaccine, while 57.1% of parents had heard of HPV and 83.2% had heard of HPV vaccine. Although the HPV-related knowledge was poor among young girls and their parents, 92% of girls indicated a positive intention to be vaccinated for herself and 88% parents would willing to consent daughter to be vaccinated if the HPV vaccine became in routine immunization. However, the parental vaccination acceptability for daughters decreased to 40% and only 30% of mothers would willing to accept for themselves, if they had to pay a full course for three doses of HPV vaccine. About 97% of school girls and 95% of parents supported that HPV vaccine should be included in government immunization programme. We also found that young girls and parents are more favor in later HPV vaccination rather than vaccination at recommended age. Cost is the dominant affecting factor in determining parental acceptability of HPV vaccination. In addition, daughter’s age, vaccine safety concern, Pap smear attendance and HPV knowledge are significantly associated with HPV vaccine acceptance. It may be worthwhile to further investigate the reasons for the delay vaccination among the young adolescent girls and among their parents, to examine if any underlying factors were unexpressed. / published_or_final_version / Public Health / Master / Master of Public Health

Cervical cancer is one of the common cancers among women and poses a great burden to the public health. Currently there are two human papillomavirus vaccines, CervarixTM and Gardasil®, against HPV type 16/18 and type 6/11/16/18 cervical cancer available in the market. Most clinical trials about immunogenicity and safety of the two vaccines were conducted among Caucasian females, rather than on Asian female populations. This systematic review aims to summarize and evaluate immunogenicity and safety of the two vaccines conducted mainly at the setting of randomized control trials on Asian female populations. This investigation would enhance understanding about whether ethnic difference impacts antibody responses, what were the severe adverse events in Asian populations, and whether the vaccines demonstrate satisfactory immunogenicity. Eleven relevant studies were identified from Pubmed and Medline with totally 4026 subjects involved. The quality and validity of these studies was critically appraised in terms of randomization, allocation ratio, blinding, analytical methods and other potential limitations. The two vaccines demonstrated high geometric mean antibody titer levels among Asian females. Injection-site pain was the mostly complained solicited local symptom, followed by redness and swelling. Few severe solicited local symptoms were reported. The unsolicited symptoms were not as common as solicited symptoms and quite a few of them were not related to the vaccination. One severe adverse event was confirmed in Japan’s study – a spontaneous abortion had taken place 15 days after vaccination. China lacks of systematic cancer registries, therefore it is difficult to estimate the disease burden. China’s Gross Domestic Product only reached $5445 per capita in 2011. HPV vaccination would not be cost-effective in the countries which had Gross Domestic Product lower than $8505 per capita, therefore piloting the HPV vaccination in major economic powerhouses like Shanghai and Beijing would be more realistic. To sum up, this systematic review demonstrated satisfactory immunogenicity on Asian females. The safety data were acceptable to some extent except one spontaneous abortion occurred in Japan’s study. / published_or_final_version / Public Health / Master / Master of Public Health