Development of an efficient strategy to improve HPV immunization coverage in Japan

A favorable impression of vaccination leads to a better vaccination rate for the human papillomavirus vaccine: A Japanese questionnaire survey investigation

Background

The Japanese vaccination rate for infants and children is seemingly excellent, except for the human papillomavirus (HPV) vaccine. Regardless of its efficacy, the inoculation rate in Japan has dropped to approximately 1 % since 2013 because of negative information about vaccine side effects. We aimed to demonstrate the factors that lead to low vaccine acceptance rates (e.g., caregiver attitudes, popular misconceptions) to inform the relevant target demographic of a stronger intention to immunize and to facilitate recovery of HPV vaccine coverage.

Methods

We conducted this study using data from two questionnaire surveys. Statistical analyses of factors affecting vaccine impressions and mediation effects of HPV vaccine impressions were performed. The difference in the knowledge about each vaccine was evaluated.

Results

Of the respondents, 95.9 % reported their intent to vaccinate their infants, whereas 58.2-78.3 % felt that they sufficiently understood the aims, efficacy, and risks of vaccination and 66.6 % had a positive impression of vaccines. Overall, 21.3 % of parents responded that they planned to have their child vaccinated against HPV, and 25.8 % had a favorable impression of this vaccine. Among factors affecting vaccine impressions, we found that parents had anxiety about vaccines when they felt that their knowledge of vaccines was insufficient. Additionally, impressions of the HPV vaccine had a mediating effect on the association between the impressions of infant vaccines and parents' intent to provide the vaccine to their children.

Conclusion

These findings show that as a society, we need to improve impressions and knowledge regarding vaccines, including but not exclusively the HPV vaccine. Moreover, although the recovery of HPV vaccine coverage is strongly desired for improving public health, simply improving impressions about the HPV vaccine or educating parents with substantive knowledge is insufficient. Instead, improving impressions and understanding of the vaccination itself is necessary.

The 'best friend effect': a promising tool to encourage HPV vaccination in Japan

BACKGROUND

In Japan, HPV vaccination rates has dramaticaly declined since 2013. Since mothers are the ones making the decision to vaccinate their daughters against HPV, we probed the mothers' intention to receive vaccinations for themselves and to vaccinate their daughters against HPV, and their reasoning.

METHODS

An internet survey was conducted in March of 2021. Through the screening, 1576 participants were extracted from a survey panel and divided into 3 groups based on their daughter's birth fiscal year (Group 1: 1994 to 1999, Group 2: 2000 to 2003, Group3: 2004 to 2008). The chi-square test and residual analysis were used for the statistical analysis of comparison among the groups. Logistic regression analysis was used to identify independent variables with mothers intention to get their daughters vaccinated under specific situations.

RESULTS

The percentage of respondents without anxiety regarding their daughter's general vaccination was significantly higher in Group 1 (p < 0.05). In the mothers of daughters born in or after 2000 when vaccination rates declined (Groups 2 and 3), a situation in which 'The daughter's best friends were vaccinated before her' made the mothers think positively about HPV vaccination, and to the same degree as a situation in which 'You received a notice from your local government recommending vaccination' (Group 2: 41.6% (214/514) and 40.5% (208/514), Group 3: 48.5% (257/530) and 47.0% (249/530)).

CONCLUSION

If mothers who have had their daughters vaccinated were to recommend HPV vaccination to their close friends, 'the best friend effect' should promote others to be vaccinated.

Challenge to improve Japan's deplorable HPV vaccination rate by local government actions

AIM

In Japan, in 2013, following reports of several alleged adverse reactions in young girls following vaccination, the previously successful national human papillomavirus infection (HPV) vaccination program collapsed rapidly. In the 8 years since vaccination rates have hovered near zero. In October of 2020, in an attempt to mitigate this lingering disaster, the Japanese Ministry of Health, Labor, and Welfare (MHLW) agency finally revised its HPV vaccination informational leaflet that was designed to be distributed by local governments nationwide. Prior to this revision, Toyonaka City, in Japan's Osaka province, had already begun sending out their own unique leaflet to girls in the targeted 6th-10th grades. As a preview of how MHLW's revised leaflet might eventually succeed, we have studied the HPV vaccination results from Toyonaka City's experiment.

METHOD

This study was a population-based analysis that compared the monthly rates of new vaccinations in girls of a targeted grade school age group. We looked at rates before and after the leaflets were sent by Toyonaka City's Division of Health Promotion and Senior Services.

RESULTS

The vaccination rates between April 2020 and March 2021 were improved across all grades; 1.2% in 6th grade (p = 0.000185), 2.5% in 7th grade (p < 0.0001), 3.5% in 8th grade (p < 0.0001), 6.8% in 9th grade (p < 0.0001), and a remarkable 16.5% in 10th grade (p < 0.0001).

CONCLUSION

When a local government sends an HPV informational leaflet targeted at young girls, it can significantly improve their HPV vaccination rates.

Alterations in 18F-FDG PET/MRI and 15O-Water PET Brain Findings in Patients With Neurological Symptoms After COVID-19 Vaccination: A Pilot Study

PURPOSE

This study aimed to investigate functional abnormalities in the brain of patients with neurological adverse effects following COVID-19 (coronavirus disease 2019) vaccination using 18F-FDG PET/MRI and 15O-water PET.

METHODS

Eight patients (1 man and 7 women, aged 26-47 years [median age, 36.5 years]) who experienced neurological symptoms after the first COVID-19 vaccination underwent CT, MRI, 18F-FDG PET/MRI, and 15O-water PET of the brain. After 7 days, each patient underwent a follow-up 18F-FDG PET/MRI and 15O-water PET of the brain. Imaging data were analyzed using visual and semiquantitative analyses, which included a cluster subtraction workflow (P = 0.05).

RESULTS

There was no evidence of vascular abnormalities, acute infarction, or hemorrhage on the CT or MRI scans. On the 15O-water PET images, 1 patient had mildly significant decreases in perfusion in the bilateral thalamus and bilateral cerebellum, and another patient showed a diffuse increase in perfusion in the cerebral white matter. The visual and semiquantitative analyses showed hypometabolism in the bilateral parietal lobes in all 8 patients on both the first and follow-up 18F-FDG PET/MRI scans. Metabolic changes in the bilateral cuneus were also observed during the first visit; all patients exhibited neurological symptoms. Moreover, 6 patients showed hypometabolism, and 2 patients showed hypermetabolism.

CONCLUSION

All regions of metabolic abnormality were part of the fear network model that has been implicated in anxiety. Our study findings support the concepts of and provide evidence for the immunization stress-related response and the biopsychosocial model.

Educational intervention for women in Japan coming of age for cervical cancer screening who grew up during the suspended HPV-vaccination-program

Girls born in 2001 became eligible for subsidized HPV vaccination when they reached 12 years old in 2013, but that was the year when the Japanese MHLW suspended its official governmental recommendation for HPV vaccination. Those girls will now reach 20 years of age this year, 2021, and they will become eligible for cervical cancer screening. We report on the effects of an educational intervention with an information sheet about their current unvaccinated defenselessness for HPV and the necessity for early and repeated cervical cancer screening as a way to improve their intention to have that screening and their attitude toward HPV vaccination. Among the educated women, 75.2% had a positive intention toward having cervical cancer screening, 24.8% had a negative intention. Educational intervention can significantly promote the intention of having cervical cancer screening in women who had experienced the suspension of the MHLW's official recommendation for HPV vaccination. As a result of this simple intervention, they were more likely to think that HPV vaccination was needed for themselves.

The Chasm We Must Cross in Japan for Re-promotion of the HPV Vaccine

In Japan, the human papillomavirus (HPV) vaccination rate has decreased from around 70% to less than 1% due to repeated media reports of diverse symptoms after HPV vaccination, and to suspension of the governmental recommendation. The challenges for re-promotion of the vaccine will be discussed from a marketing perspective. The adopter categories by which a new product penetrates the market can be divided into five groups, including Innovators, Early adopters, Early majority, Late majority, and Laggards The 16.0% line, which is the sum of the percentages of the innovators and the early adopters, is thought to be an important determinate of whether a new product will penetrate the market. By various initiatives, vaccination coverage has recently risen to about 10%; however, there is still a large chasm difficult to cross before reaching the majority of individuals. To cross that chasm, peer education will be essential. First, community health workers will need to be educated so that they have a firm understanding of HPV vaccine and can confidently recommend vaccination to the targeted population. That population will be expected to pass on that recommendation to their acquaintances, resulting in widening dissemination of HPV vaccine among the majority.

A survey of 20-year-old Japanese women: how is their intention to undergo cervical cancer screening associated with their childhood HPV vaccination status?

INTRODUCTION

In Japan, two groups of women, HPV vaccinated and unvaccinated, are approaching age 20, when they should begin cervical cancer screening. To improve Japan's current poor cervical cancer screening rate, we need to know how these women are thinking about screening.

METHODS

We conducted an internet survey of 20-y-old women, exploring their understanding of HPV and cervical cancer screening. We then gave them leaflets with basic information about HPV and cervical cancer, stressing the importance of early detection by screening. We analyzed the leaflet's effects on their attitudes based on their vaccination status.

RESULTS

Our study of 618 women found a significantly higher intention for engagement for cervical cancer screening in women HPV-vaccinated as teenagers (29% versus 17%). They were also more aware that: (1) HPV is transmitted by sexual intercourse (49.1% versus 39.2%); (2) the HPV vaccine prevents cervical cancer (49.0% to 34.0%); and (3) the appropriate cervical cancer screening interval is every 2 y (63.3% versus 56.2%). Women in both groups responded well to the leaflet, with significant improvements in intention to receive screening. However, 65%-67% were not swayed.

DISCUSSION

HPV-vaccinated women were more knowledgeable about cervical cancer and had a greater intention to receive screening. Our educational leaflet was moderately effective in both groups for increasing intentions to screen, but the majority in both groups were still resistant to screening.

CONCLUSION

Japan needs to develop more effective educational programs and tools to vigorously impart the importance of cervical cancer screening.

Health consciousness and cervical cancer screening rates in HPV-unvaccinated girls: comparison from HPV-recommended and HPV-recommendation-suspended program periods

In Japan, the vast majority of females between 13 and 24 are now unvaccinated for HPV and thus unprotected from HPV-caused cervical cancer. We analyzed the differences among these unvaccinated females regarding their understanding of the HPV vaccine, its role in cervical cancer prevention, and their need for cervical cancer screening - based on whether they refused vaccination when their government's recommendation for HPV vaccination was still in effect (vaccination-recommended group) - or during the last 7 years, while the government suspension was in effect (recommendation-suspended group). The vaccination-recommended group understood more about the HPV vaccine and the best timing for HPV vaccination than the recommendation-suspended group (p < .0001 and p = .002, respectively). We found that girls in the vaccination-recommended group had more chances to talk with the family about cervical cancer and they were more afraid of acquiring the disease (p < .0001 and p < .0001, respectively). The girls in the recommendation-suspended group tended to feel more inhibited from talking about cervical cancer with friends and acquaintances (p = .0262). The cervical cancer screening rate of the vaccination-recommended group was significantly higher (p = .014).

Parental decision-making on human papillomavirus vaccination for daughters in Japan

BACKGROUND

In June 2013, the fear of adverse events compelled the government to withdraw its recommendation of the Human papillomavirus (HPV) vaccine. Since then, the rate of vaccination among Japanese girls has dropped dramatically.

OBJECTIVE

This study aims to assess how the Japanese government's policy change against HPV vaccination influenced the degree to which parents in remote areas in Japan accepted the vaccine for their daughters, and to analyze related factors.

METHODS

A self-administered questionnaire was distributed to parents with daughters attending secondary schools or high schools in two remote areas of the country.

RESULTS

Out of 700 eligible parents, 246 (35%) responded. The percentage of parents in the "accept group" (those whose daughters had already been vaccinated or those who intended to have their daughters vaccinated) dropped from 54% before the government withdrew its HPV vaccine recommendation to only 4.5% after the withdrawal (1.5% of whom intended to vaccinate and 3% of whom had already had their daughters vaccinated). Vaccine acceptance was higher in parents who were employed as healthcare workers, had been educated through to the completion of high school, had good levels of knowledge about cervical cancer and the HPV vaccine, had low perceived barriers against the HPV vaccine, and received high levels of social support.

CONCLUSION

The acceptance of HPV vaccination among parents was low overall. Higher acceptance may be possible if the government restores its recommendation and healthcare providers disseminate appropriate information about the HPV vaccination and cervical cancer.

Japanese Mothers' Intention to HPV Vaccinate Their Daughters: How Has It Changed over Time Because of the Prolonged Suspension of the Governmental Recommendation?

The trend for cervical cancer in younger women has been increasing recently in Japan. However, as a result of the suspension of governmental recommendation, Japan’s HPV (human papillomavirus) vaccination rate for girls born since 2000 has dropped sharply. We conducted an internet survey in December of 2019, 76 months after the suspension of recommendation, to verify the intention of mothers to inoculate their daughter under current circumstances and compared with our previous surveys and leaflet intervention effect. The rates of mothers who replied that they would “inoculate” were significantly higher at 9 and 23 months, but by 32 months after the suspension the rate was significantly lower (p < 0.05, p < 0.05, p < 0.05, respectively). The rates of the mothers who replied they would not inoculate were significantly lower at 9 months and 23 months, but at 76 months was significantly higher (p < 0.05, p < 0.05, p < 0.05, respectively). We found that intervention with a leaflet that could be used under the current suspension of the governmental recommendation did not increase the mothers’ intention to inoculate their daughters. A leaflet that actively encourages vaccination may increase the intent of vaccination. It is strongly recommended that the MHLW promptly resume its recommendations for HPV vaccination.

Post-hoc analysis of injection-site reactions following vaccination with quadrivalent human papillomavirus vaccine in Japanese female clinical trial participants

AIM

The quadrivalent human papillomavirus (4vHPV) vaccine has demonstrated efficacy and immunogenicity and was generally well tolerated in clinical trials conducted in Japan. We report a detailed safety analysis of injection-site reactions in female Japanese 4vHPV clinical trial participants.

METHODS

This post-hoc analysis included data from 2 double-blind, placebo-controlled phase II clinical trials of a 3-dose (Day 1, Month 2, Month 6) regimen of 4vHPV vaccine in Japanese young women aged 18-26 years (N = 1021; NCT00378560) and girls aged 9-17 years (N = 107; NCT00411749). Injection-site and systemic adverse events (AEs) were monitored using vaccination report cards for 15 days after each vaccine dose; serious AEs were reported throughout the trials. Post-hoc analyses of data from these trials were performed to examine details of injection-site AEs, including day of onset, time from onset to resolution, and maximum intensity.

RESULTS

Injection-site AEs were reported by 85.6% of 4vHPV vaccine recipients and 72.4% of placebo recipients, most commonly erythema, pain, pruritus, and swelling (each >5% of 4vHPV vaccine recipients). The majority of injection-site AEs had an onset within 3 days of vaccination and were mild to moderate in intensity; few 4vHPV vaccine recipients reported severe injection-site AEs (2.0% overall). All injection-site AEs resolved, and most (4vHPV: 87.5%; placebo: 92.7%) resolved within 5 days of onset.

CONCLUSIONS

Most injection-site reactions are mild or moderate in intensity and of short duration. The 3-dose regimen of 4vHPV vaccine is well tolerated in Japanese female clinical trial participants based on this post-hoc analysis. These results will further support safety communication between healthcare providers and vaccine recipients regarding the HPV vaccine.

TRIAL REGISTRATION

Clinicaltrials. gov: NCT00378560 and NCT00411749.

Fathers' participation in the HPV vaccination decision-making process doesn't increase parents' intention to make daughters get the vaccine

INTRODUCTION

The HPV vaccination rate in Japan has been dismally low. Our previous survey work found that mothers in Japan, who have a strong influence over their daughters, often are receptive to the fathers' participation in the family's decision-making process about getting their daughter HPV vaccinated.

METHODS

We conducted a survey to investigate the nature of the influence of fathers' participation on the mother's decision-making process. From an internet survey panel, we selected a pool of 1,499 eligible mothers who had 12-18 years old daughters. The mothers were randomized into three Groups. To the mothers in Group A, we gave an educational leaflet regarding HPV vaccination and a second leaflet which recommended that they talk with their husbands about the vaccination. To Group B, we gave only the educational leaflet. No leaflets were sent to Group C. A structured survey questionnaire was then distributed through the internet to the mothers.

RESULTS

In Groups A, B, and C, their intention to have their daughter receive the HPV vaccine was 21.6%, 20.7% and 8.2%, respectively. The percent of Group A mothers who thought their husband's opinion was important for when they made the decision was significantly higher (70%) than in Group B (56.6%) or Group C (47.1%).

CONCLUSIONS

The fathers' participation in the mothers' decision-making does not increase the likelihood of HPV vaccination for their daughters. On the other hand, the educational leaflet proved to be effective for this cause.

Awareness and knowledge of human papillomavirus vaccination and their influential factors among Chinese women: a systematic review

Objectives

To systematically review the knowledge attitudes and the influential factors on human papillomavirus (HPV) vaccination among Chinese women.

Methods

Published studies on knowledge and attitudes of HPV vaccination for preventing cervical cancer among Chinese female population were retrieved using the major Chinese and English databases. Meanwhile, handwork retrieval was also conducted and the references including in the literature were retrieved. The quality of the literature was rigorously evaluated and extracted independently by two researchers and the data were analyzed and described by review manager 5.3 (RevMan5.3) software.

Results

In all, 19 articles including 8 articles in Chinese and 11 in English were chosen. A total of 30,176 participants were included and the sample size ranged from 64 to 6,024. The overall awareness of HPV and HPV vaccine among Chinese women was at a low level. Chinese women generally showed poor knowledge about HPV and HPV vaccine. Acceptance of HPV vaccination among Chinese women was at a high level. Vaccination intentions were influenced by the theory of planned behavior (TPB) and measured by attitudes subjective norms and perceived behavioral control.

Conclusions

The health authorities may evaluate and develop TPB-based interventions to increase HPV vaccination intentions of Chinese women. HPV vaccination programs should focus on carrying out multi-level and targeted health education and developing effective public health strategies after balancing the cost and benefit of HPV vaccine program. Medical staff should play the positive role in promoting the use of HPV vaccines in China. Integration of policy and community perspectives and multi-level interventions are essential to maximize the public health benefits of HPV vaccination.

HPV vaccination in Japan: can educational intervention promote a father's intention to encourage his daughter's vaccination?

BACKGROUND

HPV vaccines are well known to prevent several devastating HPV-associated cancers-when administered before sexual activity begins. We have previously found that mothers in Japan play an important role in a young girl's vaccination decision-making, and that educational intervention with the mothers positively changed their attitude towards the HPV vaccine. The role of fathers is still unclear. We report here similar effects can be achieved by an educational intervention with the fathers.

METHOD

We conducted an online survey of 1648 Japanese fathers as having 13-18 year-old daughters. In this group, 1450 fathers had HPV-unvaccinated daughters. Roughly half, 721, were supplied an educational sheet concerning cervical cancer, which included information regarding the safety and efficacy of the HPV vaccine, the other 729 did not receive the sheet. Afterwards, a self-administered questionnaire obtained information from both groups of fathers. We evaluated their attitudes and intentions to inoculate their daughters and willingness to be associated with the vaccination decision-making process.

RESULTS

Paternal education with an information sheet was associated with an increased odds ratio for changing the father's attitude in a positive direction, but it was not associated with improving the father's intention to their have their daughters inoculated, nor the father's willingness to be associated with the decision-making process.

CONCLUSION

While educational intervention can promote a father's positive attitude towards HPV vaccination, it is ineffective at promoting a positive intention to follow through to inoculate their daughters or improving their willingness to assist in the decision-making process.

Stopping the HPV vaccine crisis in Japan: Quantifying the benefits and risks of HPV vaccination in quality-adjusted life-years for appropriate decision-making

BACKGROUND

The human papilloma virus (HPV) vaccination coverage rate in Japan has dropped dramatically from more than 70% to less than 1% since 2013. With conflicting information and a lack of quantification of the benefits and risks of the HPV vaccine, parents have been hindered in making their decision. We quantified the benefits and risks of the HPV vaccine in terms of quality-adjusted life-years (QALYs), to help their informed decision.

METHOD

A literature search was performed to determine the incidence and burden of each outcome in a decision tree model. The benefits and the risks of the HPV vaccination were determined in QALY change with a sensitivity analysis.

RESULT

The benefits of the HPV vaccine in terms of QALYs gained were 703.72, 14.45, and 30.83/100,000 persons for cervical cancer, cervical intraepithelial neoplasm 3 (CIN 3), and genital warts, respectively. The QALY loss due to acute adverse reactions, chronic adverse reactions without assistance needs, and chronic adverse reactions with assistance needs were 0.07, 5.83, and 5.82/100,000 persons, respectively. The risk/benefit ratio in QALY change in the base case was 0.0156. In all scenarios, the benefit of the HPV vaccine was significantly greater than the risk.

CONCLUSION

The benefits are much greater than the risks, even if it is assumed that all reported adverse events were due to the vaccination. The Japanese government and health care providers should immediately recommend the HPV vaccine to all adolescent girls irrespective of any causal links between the vaccine and reported adverse events.

Factors associated with cervical cancer screening among young unmarried Japanese women: results from an internet-based survey

BACKGROUND

The prevalence of cervical cancer among women aged 20-30 years has been increasing. A better understanding of the factors correlated with cervical cancer screening is vital to better identify suitable candidates and develop effective interventions. However, few studies have examined factors correlated with cervical cancer screening using a quantitative research design. Thus, this study aimed to assess the prevalence of and factors correlated with cervical cancer screening among unmarried and sexually active Japanese women aged 20-29 years.

METHODS

Seven hundred Japanese women who responded to an internet-based cross-sectional survey conducted by a marketing research company in 2015 were enrolled. Associations between lifetime cervical cancer screening and demographic profile, sexual behavior, and psychosocial factors were assessed via univariate analysis. Variables indicating significance (P < 0.05) were used in the univariate analysis to determine adjusted odds ratios (AOR).

RESULTS

Overall, 383 (54.7%) respondents underwent cervical cancer screening during their lifetime. Multiple regression analysis indicated that age, employment status, income, lifetime number of sex partners, human papillomavirus (HPV) vaccination, receipt of a free coupon for cervical cancer screening from the local government, perceived susceptibility and logistical barriers (cost/time), and confidence of receiving Pap testing from a male physician were significantly correlated with lifetime cervical cancer screening. Individuals aged 28-29 years (AOR = 1.86) and those with full-time employment (AOR = 3.30), income ≥ ¥ 4,000,000($35,000) (AOR = 1.60), > 5 lifetime sex partners (AOR = 1.97), HPV vaccination (AOR = 4.88), coupon from the local government (AOR = 3.14), higher perceived level of cervical cancer susceptibility (middle, AOR = 1.77; high, AOR = 3.23), lower perceived logistical barriers (middle, AOR = 0.55; high, AOR = 0.31), and higher confidence of receiving pap testing from a male physician (AOR = 2.66) were more likely to undergo cervical cancer screening.

CONCLUSIONS

Women who were younger and unemployed and those with lower perceived cervical cancer susceptibility, higher perceived logistical barriers, and lower confidence of receiving Pap testing from a male physician were less likely to undergo lifetime cervical cancer screening. Thus, to increase the cervical cancer screening rate among young women, it may be effective to target younger unemployed women, provide interventions to increase perceived susceptibility, and recommend tests while considering psychosocial barriers.

Time-dependent changes of the intention of mothers in Japan to inoculate their daughters with the HPV vaccine after suspension of governmental recommendation

In Japan, the trend for cervical cancer at younger ages has been increasing. As a countermeasure, the HPV vaccine was introduced as a routine vaccination in April 2013. However, the Ministry of Health, Labour and Welfare (MHLW) announced a “Suspension of its active inoculation recommendation for HPV vaccine” in June 2013. In 2016, 32 months after that suspension, we conducted survey via Internet and compared the results with our previous ones conducted at 9 and 23 months after suspension (in 2014 and 2015, respectively). We examined the ‘time-dependent change’ of the ‘intention of mothers to inoculate their daughters with the HPV vaccine’ in terms of efficacy of external decision-making support. 17.5% of mothers in the first survey replied that they would inoculate their daughters under the current circumstances, 12.1% in the second survey, and 6.7% in the third, showing a consistent decrease in willingness over time (p = 0.03, p < 0.01). If the government recommendation were to be reintroduced, 22.5% of mothers in the first survey replied they would inoculate their daughters, 21.0% in the second survey, which indicated no significant difference (p = 0.65) over the first interval; however, this was significantly decreased to 12.2% in the third survey (p < 0.01). Our study revealed that the intention to inoculate their daughters has been declining among Japanese mothers over time triggered by the suspension.

Contents of Japanese pro- and anti-HPV vaccination websites: A text mining analysis

OBJECTIVE

In Japan, the human papillomavirus (HPV) vaccination rate has sharply fallen to nearly 0% due to sensational media reports of adverse events. Online anti-HPV-vaccination activists often warn readers of the vaccine's dangers. Here, we aimed to examine frequently appearing contents on pro- and anti-HPV vaccination websites.

METHODS

We conducted online searches via two major search engines (Google Japan and Yahoo! Japan). Targeted websites were classified as "pro," "anti," or "neutral" according to their claims, with the author(s) classified as "health professionals," "mass media," or "laypersons." We then conducted a text mining analysis.

RESULTS

Of the 270 sites analyzed, 16 contents were identified. The most frequently appearing contents on pro websites were vaccine side effects, preventable effect of vaccination, and cause of cervical cancer. The most frequently appearing contents on anti websites were vaccine side effects, vaccine toxicity, and girls who suffer from vaccine side effects. Main disseminators of each content according to the author's expertise were also revealed.

CONCLUSION

Pro-HPV vaccination websites should supplement deficient contents and respond to frequent contents on anti-HPV websites.

PRACTICE IMPLICATIONS

Effective tactics are needed to better communicate susceptibility to cervical cancer, frequency of side effects, and responses to vaccine toxicity and conspiracy theories.

HPV vaccination in Japan: results of a 3-year follow-up survey of obstetricians and gynecologists regarding their opinions toward the vaccine

Background

In Japan, the cervical cancer preventative HPV vaccination rate has dramatically declined, directly as a result of repeated broadcasts of so-called adverse events and the resulting suspension of the government’s recommendation. Our previous survey of obstetricians and gynecologists in Japan regarding their opinions toward HPV vaccination revealed that these key specialists were as negatively influenced by the reports of purported negative events as were the general population. Here, we report a 3-year follow-up survey of these clinicians.

Methods

We reused the same questionnaire format as used in our 2014 survey, but added new questions concerning opinions regarding a WHO statement and reports of a Japanese nation-wide epidemiological study related to the adverse events, released in 2015 and 2016, respectively.

Results

The response rate was 46% (259/567): 5 (16.1%) of 31 doctors had inoculated their own teenaged daughters during the time period since the previous survey, despite the continued suspension of the governmental recommendation, whereas in the previous survey none of the doctors had done so. Among the respondents, the majority claimed awareness of the recent pro-vaccine WHO statement (66.5%), and of the report of a Japanese epidemiological study (71.5%), and a majority affirmed they currently held positive opinions of the safety (72.7%) and effectiveness (84.3%) of the HPV vaccine.

Conclusions

Our re-survey of Japan’s obstetricians and gynecologists regarding their opinions about the HPV vaccine found that their opinions have changed, potentially leading to a more positive future re-engagement for HPV vaccination in Japan.

Progress in prophylactic human papillomavirus (HPV) vaccination in 2016: A literature review

Prophylactic human papillomavirus (HPV) vaccine represents a revolutionary step forward in preventing HPV-related cancers, especially cervical carcinoma. Alongside appropriate screening, it has the potential to dramatically reduce cervical cancer incidence and even eradicate it. Following extensive evaluations in clinical trials, the first decade of routine HPV vaccine use provides overwhelming evidence of the vaccines' safety and their real-life effectiveness. In 2016, further clinical trials showed high vaccine efficacy in adult women, especially those that were HPV DNA-negative at baseline, and indicated possible protection from HPV-related diseases after treatment of precancerous cervical lesions. The recommendation for a two-dose schedule in individuals under 15 is further supported for all three licensed vaccines by immunogenicity studies that show non-inferior immune responses and similar clinical efficacy compared to the three-dose schedule. So far, natural competition between HPV types has not been confirmed and therefore vaccine-induced clinically significant type replacement is unlikely. The real-world effectiveness data showed cross-sectional reduction in the prevalence/incidence of vaccine-related HPV types, genital warts and precancerous cervical lesions in countries and regions with HPV vaccination coverage. These declines were evident not only in vaccinated females, but also in unvaccinated females and males, strongly suggesting herd protection. Despite an excellent safety profile consistently demonstrated in clinical trials and confirmed in real-life settings, recently invented controversial syndromes allegedly linked to HPV vaccines temporarily compromised some previously very successful vaccination programs and significantly contributed to the failure of HPV vaccine implementation in some countries with the highest prevalence of cervical cancer. However, several safety studies failed to confirm any association of these syndromes with HPV vaccination in various settings and geographic locations. The main challenges remain implementing HPV vaccination in national vaccination programs, especially in low-and middle-income countries with the highest burden of cervical cancer, and achieving and sustaining high vaccine coverage rates.