Significant Reduction in the Incidence of Genital Warts in Young Men 5 Years Into the Danish Human Papillomavirus Vaccination Program for Girls and Women

BACKGROUND:

Denmark introduced the quadrivalent human papillomavirus vaccine into the vaccination program for 12- to 15-year-old girls in 2008 to 2009. In 2012, the program was supplemented with a catch-up program for women aged up to 27 years. We evaluated the effectiveness of the Danish vaccination program on the nationwide incidence of genital warts (GWs), after the second catch-up by including information on both hospital treatments and on self-administered treatment with podophyllotoxin. Genital wart incidence was investigated in both sexes; however, the main focus was on potential herd protection of men.

METHODS:

Incident cases of GWs were identified from the Danish National Patient Register and through redemptions of prescription for podophyllotoxin in the Danish National Prescription Registry in 2006 to 2013. Age-specific incidence rates (IRs) were assessed, and estimated annual percentage change (EAPC) was calculated by Poisson regression.

RESULTS:

Genital wart incidence was either stable or increased in both sexes in 2006 to 2008. After introduction of the vaccination program, GW incidence decreased significantly in women aged 12 to 35 years and men aged 12 to 29 years, with rapid decrease among 16- to 17-year-olds (IRwomen, from 1071 to 58 per 100,000 person-years [EAPC, -55.1%; 95% confidence interval, -58.7 to-51.2]; IRmen, from 365 to 77 per 100,000 person-years [EAPC, -36.6%; 95% confidence interval, -40.5 to -32.5] in 2008-2013).

CONCLUSIONS:

We found a significantly decreasing incidence of GWs in women up to 35 years of age after the start of the human papillomavirus vaccination program. A similar pattern was observed for men aged 12 to 29 years, indicating substantial herd protection.

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By:  Bollerup S1, Baldur-Felskov B, Blomberg M, Baandrup L, Dehlendorff C, Kjaer SK.

• 1From the *Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; †Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark; and ‡Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
• Sex Transm Dis. 2016 Apr;43(4):238-42. doi: 10.1097/OLQ.0000000000000418. 

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Rapid Acquisition of HPV Around the Time of Sexual Debut in Adolescent Girls in Tanzania

BACKGROUND:

No reports exist on genotype-specific human papillomavirus (HPV) acquisition in girls after first sex in sub-Saharan Africa, despite high HPV prevalence and cervical cancer incidence.

METHODS:

We followed 503 HP-unvaccinated girls aged 15-16 years in Mwanza, Tanzania, 3-monthly for 18 months with interviews and self-administered vaginal swabs. Swabs were tested for 13 higHRisk and 24 low-risk HPV genotypes. Incidence, clearance and duration of overall HPV and genotype-specific infections were calculated and associated factors evaluated.

RESULTS:

A total of 106 participants reported first sex prior to enrolment (N = 29) or during follow-up (N = 77). One was HIV-positive at the final visit. The remaining 105 girls contributed 323 adequate specimens. Incidence of any new HPV genotype was 225/100 person-years (pys), and incidence of vaccine types HPV-6, -11, -16 and -18 were 12, 2, 2 and 7/100 pys, respectively. Reporting sex in the past 3 months and knowing the most recent sexual partner for a longer period before sex were associated with HPV acquisition. Median time from reported sexual debut to first HPVinfection was 5 months, and infection duration was 6 months.

CONCLUSION:

This is the first description of HPV acquisition after first sex in sub-Saharan Africa where the incidence of cervical cancer is amongst the highest in the world. HPV incidence was very high after first sex, including some vaccine genotypes, and infection duration was short. This very high HPV incidence may help explain high cervical cancer rates, and supports recommendations that the HPV vaccine should be given to girls before first sex.

Below:  Time from sexual debut to first infection with any HPV, any HR HPV or any LR HPV, among 41 girls who reported sexual debut during follow-up and were HPV-naïve at time of reported sexual debut.  Kaplan Meier curves are calculated separately for each HPV group.

Full article at:   http://goo.gl/QhwwIr

   

By:  Houlihan CF1, Baisley K2, Bravo IG3, Kapiga S4, de Sanjosé S5, Changalucha J6, Ross DA2, Hayes RJ2, Watson-Jones D7.

• 1Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK Mwanza Intervention Trials Unit, Mwanza, Tanzania catherine.houlihan@lshtm.ac.uk.
• 2MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
• 3Unit of Infections and Cancer, Institut Català d'Oncologia, Barcelona, Spain.
• 4Mwanza Intervention Trials Unit, Mwanza, Tanzania MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
• 5Unit of Infections and Cancer, Institut Català d'Oncologia, Barcelona, Spain CIBER ESP, Barcelona, Spain.
• 6National Institute for Medical Research, Mwanza, Tanzania.
• 7Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK Mwanza Intervention Trials Unit, Mwanza, Tanzania. 
• Int J Epidemiol. 2016 Mar 4. pii: dyv367.

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Human Papilloma Virus Awareness among Hispanic Females with Inflammatory Bowel Disease

Women with inflammatory bowel disease (IBD) may be at increased risk of human papilloma virus (HPV) infection and HPV-related malignancies, as many are immunocompromised secondary to the use of immunosuppressant agents. 

Several studies have addressed the knowledge about cervical cancer risk factors in different populations, particularly HPV infection and its association with cervical malignancies; most of these studies show poor patient knowledge. 

The purpose of this study is to describe the knowledge of females with IBD about HPV infection and the HPV vaccine. We performed a cross-sectional study in 147 consecutive patients attending the clinics of the University of Puerto Rico Center for IBD from 2009 to 2010. An interviewer-administered questionnaire was used to collect information on demographics, lifestyles, and HPV-related knowledge of participants. Bivariate analysis using the chi-square statistics and Fisher’s exact test was used to examine factors associated with HPV awareness. 

The mean age of participants was 36.6 years (SD = 13.91 years). Three fourth (77 %) of women had awareness of the existence of HPV, and 58 % did know about the existence of HPV vaccines. Among those who had heard about HPV, 79.6 % knew that HPV can cause cervical cancer, and 57.5 % knew that the virus is sexually transmitted. Among those who knew of the vaccine, 75.3 % learned about its existence through the media, while only 15.3 %, through their health-care provider. Only three women within recommended ages (2 %) had been vaccinated against HPV, although 50 % of participants indicated that they would definitely/probably vaccinate against HPV in the future. 

A significant trend was observed, where more educated women were more likely to have heard of HPV (p for trend = 0.0017). Women who were high school graduates/some college (OR = 6.63, 95 % CI = 1.71–25.66) and those with at least an associate degree (OR = 11.69, 95 % CI = 3.05–45.89) were more likely to be aware of the HPV vaccine than women without a high school degree. 

Our study documents poor knowledge of HPV and HPV vaccine in this population of IBD patients in Puerto Rico. Although vaccination coverage is low in this population, women are receptive to the possibility of vaccination in the future. Given that this population may be at an increased risk of HPV infection and related morbidities, education and vaccination programs should be promoted among them.

Full article at:   http://goo.gl/8s8mRk

By:  José E. Rivera-Acosta,* Maysabel Aponte, Irene Villamil, Josefina Romaguera, Ana P. Ortiz, and Esther A. Torres

Division of Gastroenterology, Department of Medicine, University of Puerto Rico School of Medicine, PO Box 365067, San Juan, PR 00936-5067 Puerto Rico

University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico

José E. Rivera-Acosta, Phone: (787) 598-1555, Email: ude.rpu@021arevir.esoj.

*Corresponding author.

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LGBT Health & Vaccinations: Findings from a Community Health Survey of Lexington-Fayette County, Kentucky

Data on adult immunization coverage at the state level and for LGBT Americans in particular are sparse. 

This study reports the results of a 2012 Lexington-Fayette County, Kentucky, community health assessment's results asking about eight adult vaccinations among 218 lesbian, gay, bisexual, and transgendered (LGBT) respondents. Researchers collected data using an online survey distributed through LGBT social media, posters, and LGBT print media. The LGBT sample largely matches the demographics of the county as a whole except this group reports higher level of education and fewer uninsured individuals. 

Among LGBT respondents, immunization prevalence reaches 68.0% (annual Influenza), 65.7% (Hepatitis B), 58.8% (Chickenpox/Varicella), 55.9% (Hepatitis A), 41.2% (Smallpox), and 25.8% (Pneumonia). Among respondents who are currently within the recommended 19-26 years age range for the Human Papillomavirus (HPV) vaccine, the LGBT females are less likely to report receiving the vaccine (15.4%) compared to the national coverage percentage of 34.5%. Males, however, are more likely to have received the vaccine (10.3%) than the national percentage of 2.3%. 

The small number of LGBT seniors in the study report a much higher prevalence of the Shingles (Herpes Zoster) vaccines than for U.S. seniors 60 and older (71.4% compared to 20.1% nationally). LGBT respondents report higher percentages of adult vaccination.

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By:  Jones J1, Poole A2, Lasley-Bibbs V3, Johnson M4.

• 1Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460, USA. Electronic address: jajones@georgiasouthern.edu.
• 2Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460, USA.
• 3Office of Health Equity Kentucky Dept. for Public Health, 275 E. Main Street, Frankfort, KY 40621-0001, USA. Electronic address: vivian.lasley-bibbs@ky.gov.
• 4Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460, USA; Office of Health Equity Kentucky Dept. for Public Health, 275 E. Main Street, Frankfort, KY 40621-0001, USA.
• Vaccine. 2016 Feb 27. pii: S0264-410X(16)00235-8. doi: 10.1016/j.vaccine.2016.02.054 

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Uptake of Cervical Cancer Screening and Associated Factors among Women in Rural Uganda: A Cross Sectional Study

Background

In developing countries, inadequate access to effective screening for cervical cancer often contributes to the high morbidity and mortality caused by the disease. The largest burden of this falls mostly on underserved populations in rural areas, where health care access is characterized by transport challenges, ill equipped health facilities, and lack of information access. This study assessed uptake of cervical cancer screening and associated factors among women in rural Uganda.

Methods

This descriptive cross sectional study was carried out in Bugiri and Mayuge districts in eastern Uganda and utilised quantitative data collection methods. Data were collected using a semi-structured questionnaire on cervical cancer screening among females aged between 25 and 49 years who had spent six or more months in the area. Data were entered in Epidata 3.02 and analysed in STATA 12.0 statistical software. Univariate, bivariate and multivariate analyses were performed.

Results

Of the 900 women, only 43 (4.8%) had ever been screened for cervical cancer. Among respondents who were screened, 21 (48.8%) did so because they had been requested by a health worker, 17 (39.5%) had certain signs and symptoms they associated with cervical cancer while 16 (37.2%) did it voluntarily to know their status. Barriers to cervical cancer screening were negative individual perceptions 553 (64.5%) and health facility related challenges 142 (16.6%). Other respondents said they were not aware of the screening service 416 (48.5%). The independent predictors of cervical cancer screening were: being recommended by a health worker [AOR = 87.85, p<0.001], knowing where screening services were offered [AOR = 6.24, p = 0.004], and knowing someone who had ever been screened [AOR = 9.48, p = 0.001].

Conclusion

The prevalence of cervical cancer screening is very low in rural Uganda. Interventions to increase uptake of cervical cancer screening should be implemented so as to improve access to the service in rural areas.

Below:  Suggested measures for increasing uptake of cervical cancer screening services

Full article at:   http://goo.gl/rQQ6D8

By:  

Rawlance Ndejjo, Trasias Mukama, David Musoke

Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Angele Musabyimana

Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda

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Predictors of Human Papillomavirus Vaccination among Young Men Who Have Sex with Men

BACKGROUND:

Human papillomavirus (HPV) is a common sexually transmitted infection that causes anal, penile, and oropharyngeal cancers in men. Men who have sex with men (MSM) are at particularly high risk for HPV infection and HPV-related disease. Human papillomavirus vaccination is currently recommended for all MSM in the United States through age 26 years, yet little is known about HPV vaccine uptake in this population. The purpose of this study was to identify predictors of HPV vaccine uptake and barriers and facilitators to HPV vaccination that may be unique to young MSM.

METHODS:

Men aged 18 to 26 years (n = 336) were recruited via advertisements placed on a geospatial smartphone dating application designed for MSM. Participants completed an online survey. Correlates of vaccine uptake and provider recommendation for HPV vaccine were identified using logistic regression.

RESULTS:

In total, 21% of participants had received at least 1 dose of HPV vaccine. Provider recommendation was the strongest predictor of uptake such that MSM with a recommendation were more than 40 times more likely to have been vaccinated. Additional predictors of uptake included age and HPV vaccine attitudes. Predictors of provider recommendation included sexual identity, race/ethnicity, condomless anal sex, and HIV status. Psychosocial correlates and barriers and facilitators to HPV vaccination among unvaccinated men were also identified.

CONCLUSIONS:

Findings highlight potential disparities in HPV vaccine uptake, as well as disparities in provider recommendation practices for HPV vaccination. Future interventions should aim to clarify misconceptions, modify psychosocial beliefs, and address barriers and facilitators to HPV vaccine uptake specific to young MSM.

Purchase full article at:   http://goo.gl/VyFy53

By:  Gerend MA1, Madkins K, Phillips G 2nd, Mustanski B.

• 1From the *Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL; and †Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL. 
• Sex Transm Dis. 2016 Mar;43(3):185-91. doi: 10.1097/OLQ.0000000000000408.

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Trends in Genital Warts by Socioeconomic Status After the Introduction of the National HPV Vaccination Program in Australia: Analysis of National Hospital Data

BACKGROUND:

Human papillomavirus (HPV) vaccination targeting females 12-13 years commenced in Australia in 2007, with catch-up of females 13-26 years until the end of 2009. No analyses of HPV vaccination program impact by either socioeconomic or geographic factors have been reported for Australia.

METHODS:

Hospital admissions between July 2004-June 2011 involving a diagnosis of genital warts were obtained from a comprehensive national database. We compared sex- and age-specific admission rates in July 2006-June 2007 (pre-vaccination period) and July 2010-June 2011 (post-vaccination period) according to Index of Relative Socio-economic Disadvantage, nationally and stratified by remoteness area relating to the individual's area of residence, using Poisson/ negative binomial models.

RESULTS:

Admission rates per 100,000 population in females aged 10-19 years (predominantly vaccinated at school), reduced from 42.2 to 6.0 (rate reduction 86.7 %; 95 % CI:82.2-90.0 %) in more disadvantaged areas and from 26.8 to 4.0 (85.0 %; 95 % CI:79.7-88.9 %) in less disadvantaged areas. In females aged 20-29 years (predominantly vaccinated in the community), the decreases were from 73.9 to 26.4 (66.0 %; 95 % CI:57.7-72.6 %) and from 61.9 to 23.8 (61.6 %; 95 % CI:52.9-68.7 %) in more and less disadvantaged areas, respectively. The reductions were similar in more vs less disadvantaged areas both inside major cities (88.6 %; 95 % CI: 82.2-92.7 % vs 87.9 %; 95 % CI:82.6-91.6 % in females aged 10-19 years; 64.0 %; 95 % CI:57.0-69.9 % vs 63.8 %; 95 % CI:52.9-72.1 % for females aged 20-29 years) and outside major cities (88.8 %; 95 % CI: 83.7-92.3 % vs 85.8 %; 95 % CI:73.5-92.4 % in females aged 10-19 years; 71.1 %; 95 % CI:58.8-79.7 % vs 67.6 %; 95 % CI:48.2-79.8 % for females aged 20-29 years). Admission rates in males aged 20-29 years also reduced, by 23.0 % (95 % CI:4.8-37.8 %) and 39.4 % (95 % CI:28.9-48.3 %) in more versus less disadvantaged areas respectively.

CONCLUSIONS:

The relative reduction in genital warts appears similar in young females across different levels of disadvantage, including within and outside major cities, both for females predominantly vaccinated at school and in the community.

Below:  Admissions involving a diagnosis of genital warts (per 100,000 population), by age and socioeconomic status, in a) females and b) males. Males aged 10–19 years were excluded due to the small number of admissions

Below:  Admissions involving a diagnosis of genital warts (per 100,000 population), by age, socioeconomic status and remoteness area of residence. a Females 10–19 years; b Females 20–29 years; c Females 30–39 years; d Males 20–29 years; e Males 30–39 years

Below:  Admission rate ratio (relative to pre-vaccination mean) by age, SES and remoteness area of residence (females). a and b 10–19 years; c and d 20–29 years; e and f 30–39 years

Below:  Admission rate ratio (relative to pre-vaccination mean) by age, SES and remoteness area of residence (males). a and b 20–29 years; c and d 30–39 years

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By:  Smith MA1,2,3, Liu B4,5, McIntyre P6, Menzies R7,8,9, Dey A10, Canfell K11,12,13.

• 1School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia. megan.smith@nswcc.org.au.
• 2Prince of Wales Clinical School, UNSW Australia, Sydney, NSW, 2052, Australia. megan.smith@nswcc.org.au.
• 3Present address: Cancer Research Division, Cancer Council NSW, Kings Cross NSW 1340, PO Box 572, Sydney, NSW, 2011, Australia. megan.smith@nswcc.org.au.
• 4School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia. bette.liu@unsw.edu.au.
• 5The Sax Institute, Sydney, PO Box K617, Haymarket, NSW, 1240, Australia. bette.liu@unsw.edu.au.
• 6National Centre for Immunisation Research and Surveillance Children's Hospital, Westmead, Locked Mail Bag 4001, Sydney, 2145, NSW, Australia. peter.mcintyre@health.nsw.gov.au.
• 7National Centre for Immunisation Research and Surveillance Children's Hospital, Westmead, Locked Mail Bag 4001, Sydney, 2145, NSW, Australia. r.menzies@unsw.edu.au.
• 8Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia. r.menzies@unsw.edu.au.
• 9Present address: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia. r.menzies@unsw.edu.au.
• 10National Centre for Immunisation Research and Surveillance Children's Hospital, Westmead, Locked Mail Bag 4001, Sydney, 2145, NSW, Australia. aditi.dey@health.nsw.gov.au.
• 11School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia. karen.canfell@nswcc.org.au.
• 12Prince of Wales Clinical School, UNSW Australia, Sydney, NSW, 2052, Australia. karen.canfell@nswcc.org.au.
• 13Present address: Cancer Research Division, Cancer Council NSW, Kings Cross NSW 1340, PO Box 572, Sydney, NSW, 2011, Australia. karen.canfell@nswcc.org.au. 
• BMC Infect Dis. 2016 Feb 1;16(1):52. doi: 10.1186/s12879-016-1347-z.

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The Role of Anticipated Regret & Health Beliefs in HPV Vaccination Intentions among Young Adults

Although cognitions have predicted young adults' human papillomavirus (HPV) vaccine decision-making, emotion-based theories of healthcare decision-making suggest that anticipatory emotions may be more predictive. 

This study examined whether anticipated regret was associated with young adults' intentions to receive the HPV vaccine above and beyond the effects of commonly studied cognitions. 

Unvaccinated undergraduates (N = 233) completed a survey assessing Health Belief Model (HBM) variables (i.e., perceived severity of HPV-related diseases, perceived risk of developing these diseases, and perceived benefits of HPV vaccination), anticipatory emotions (i.e., anticipated regret if one were unvaccinated and later developed genital warts or HPV-related cancer), and HPV vaccine intentions. 

Anticipated regret was associated with HPV vaccine intentions above and beyond the effects of HBM variables among men. Among women, neither anticipated regret nor HBM variables showed consistent associations with HPV vaccine intentions. 

Findings suggest that anticipatory emotions should be considered when designing interventions to increase HPV vaccination among college men.

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By:  Christy SM1,2, Winger JG3, Raffanello EW4, Halpern LF4, Danoff-Burg S5, Mosher CE3.

• 1Health Outcomes and Behavior Program, Division of Population Science, Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr., MRC-CANCONT, Tampa, FL, 33612, USA. shannon.christy@moffitt.org.
• 2Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA. shannon.christy@moffitt.org.
• 3Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
• 4Department of Psychology, University at Albany-SUNY, Albany, NY, USA.
• 5New Knowledge Organization, Oceanside, CA, USA. 
• J Behav Med. 2016 Jan 18. 

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Incarcerated Women's HPV Awareness, Beliefs, and Experiences

PURPOSE:

The purpose of this paper is to explore incarcerated women's awareness, beliefs, and experiences with human papillomavirus (HPV) infection and vaccination.

DESIGN/METHODOLOGY/APPROACH:

Researchers conducted focus groups with 45 incarcerated women in an urban Midwestern US jail to assess how women talked about their Papanicolaou (Pap) test screening and abnormal Pap test follow-up experiences. Some focus group questions specifically assessed individual awareness, beliefs, and experiences with HPV infection and vaccination. Based on these data, the authors described participants' awareness of HPV, as well as used open coding to ultimately extract themes related to beliefs and experiences with HPV infection and vaccine.

FINDINGS:

While all 45 participants reported experiencing an abnormal Pap test event within the last five years, only two-thirds of participants (n=30) reported having heard of the HPV infection. Several themes emerged from the analysis of the data: the women's beliefs about cause and severity of HPV; frustration with age requirements of the vaccine; varied experiences with vaccinations for themselves and their children; the impact of media exposure on knowledge; and desire for more HPV infection and vaccine information.

ORIGINALITY/VALUE:

Incarcerated women's awareness and limited experiences with HPV infection and vaccination may be a barrier to adequate screening and cervical cancer prevention. This study has implications for the development of cervical health education for this high-risk group of women, who are four to five times as likely to have cervical cancer as non-incarcerated women

  

Full article at:   http://goo.gl/t7BQTu

By:  Pankey T1, Ramaswamy M.

• 1Department of Counseling Psychology (https://counselingpsych.education.wisc.edu/), University of Wisconsin - Madison, Madison, WI, USA. 

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Human Papillomavirus Infection and Vaccination: Awareness and Knowledge of HPV and Acceptability of HPV Vaccine among Mothers of Teenage Daughters in Weihai, Shandong, China

In preparation for the introduction of human papillomavirus (HPV) vaccine, we investigated awareness and knowledge of HPV/HPV vaccine and potential acceptability to HPV vaccine among mothers with a teenage daughter in Weihai, Shandong, China. 

A cross-sectional survey was conducted in 2013 with a sample of 1850 mothers who had a daughter (aged 9-17 years) attending primary, junior and senior high schools. In the final sample (N = 1578, response rate 85.30%), awareness of HPV was reported by 305 (19.32%) mothers. Awareness varied significantly by daughter's age (P<0.01), mother's education level (P<0.01), mother's occupation (P<0.01), household income (P<0.01) and residence type (P<0.01). 

Knowledge about HPV/HPV vaccine was poor with a mean total score of 3.56 (SD = 2.40) out of a possible score of 13. Mothers with a higher education level reported higher levels of knowledge (P = 0.02). Slightly more than one-fourth (26.49%) of mothers expressed their potential acceptability of HPV vaccine for their daughters. 

Acceptability increased along with increased daughters' age (P<0.01), household income (P<0.01) and knowledge level (P<0.01). House wives and unemployed mothers had the highest acceptability (P<0.01). The most common reasons for not accepting HPV vaccination were "My daughter is too young to have risk of cervical cancer (30.95%)", "The vaccine has not been widely used, and the decision will be made after it is widely used (24.91%)", "Worry about the safety of the vaccine (22.85%)". 

Awareness and knowledge of HPV/HPV vaccines are poor and HPV vaccine acceptability is low among these Chinese mothers. 

These results may help inform appropriate health education programs in this population.

Full article at: http://goo.gl/S9wBIx

By:  Yu Y1, Xu M2, Sun J3, Li R1, Li M1, Wang J1, Zhang D2, Xu A4,5.

• 1Weihai Center for Disease Control and Prevention, Weihai, Shandong, PR China.
• 2Medical College, Qingdao University, Qingdao, Shandong, PR China.
• 3Queensland University of Technology, Brisbane, Queensland, Australia.
• 4Academy of Preventive Medicine, Shandong University, Jinan, Shandong, PR China.
• 5Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, Shandong, PR China.
• PLoS One. 2016 Jan 14;11(1):e0146741. doi: 10.1371/journal.pone.0146741. eCollection 2016. 

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