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Journal of Human Growth and Development

versão impressa ISSN 0104-1282versão On-line ISSN 2175-3598

J. Hum. Growth Dev. vol.28 no.1 São Paulo jan./mar. 2018

https://doi.org/10.7322/jhgd.143887 

EDITORIAL

 

HPV vaccine: knowledge and acceptance to ensure effectiveness

 

 

Isabel Cristina Esposito SorpresoI; Patricia Jane KellyII

IDisciplina de Ginecologia. Departamento de Obstetrícia e Ginecologia da Faculdade de Medicina da Universidade de São Paulo
IISchool of Nursing. University of Missouri

Correspondence

 

 


ABSTRACT

The new Vaccine technologies against transmissible and non-transmissible diseases, such as cancer, have had an impact on international public health. The human papillomavirus (HPV) vaccine is used on a large scale in immunization programs in more than 58 countries, with resultant efficacy and safety for precursor lesions of cervical cancer, in addition to anogenital lesions. After the introduction of quadrivalent HPV vaccine (6,11,16 and 18) in Brazil in 2014, monitoring the vaccination coverage and the development of HPV prevalence incidence of cervical abnormalities and precancerous lesions must be observed, as well as morbidity and mortality trends from in situ and invasive cancer. Encouraging information, counseling and continuing education is recommended as a strategy to broaden vaccine acceptance in order to sediment its implementation and ensure effectiveness in reducing new cases of cervical cancer in the future.

Keywords:  HPV, papillomavirus vaccines, human papillomavirus recombinant vaccine quadrivalent, types 6;11;16;18, uterine cervical neoplasms


 

 

Cervical cancer contributes to morbidity and mortality among women in Latin America; prevention, with early detection and health promotion essential in addressing the problem1,2. The estimated 16,340 new cases make cervical cancer the second most common neoplasm in the Northeast region3. The persistence of new cases and the high incidence in certain regions of the country are related to HPV (human papillomavirus) infection with high oncogenic risk (ability to cause pre-malignant lesions, in situ and invasive cancer), persistence of infection; contributing factors include low socioeconomic level, other genital infections, immunosuppression and genetic causes. The prevalence of high-risk oncogenic HPV in specific territories and populations combine with the ethnic or racial differences that exist in our country2-4. Research to identify the particulars in each territory are important for HPV prevention, early detection of precursor lesions and actions in health promotion as continuing education for professionals and health education in the self-care of the population in general and the vulnerable3,4.

Since 2014, the National Immunization Program of the Ministry of Health (PNI-MS) has provided the quadrivalent HPV vaccine (6,11,16 and 18) for girls aged 9-14 years, including women living with HIV up to 26 years; 12 and 13 year-old boys and 9 to 26 year-old boys and men with HIV under medical guidance have also been added4. The primary prevention represented by condom use and a quadrivalent vaccine for HPV, as well as the advent of new vaccines (such as the "nonavalente" vaccine) represent a technological advance in health and a gain for women's health in the short and long term5.

Countries that have adopted the quadrivalent vaccine have reported reduction of precursor lesions from 60-80%, with rates of 100% in populations vaccinated with the quadrivalent vaccine (6, 11, 16 and 18) for cases of genital warts5-7.

The optimal timing of vaccination for HPV is recommended prior to the first sexual contact of an individual. Vaccine efficacy in men and women suggests that immunization is more effective among individuals who have not been infected with HPV and reduces the morbidity of young women related to precursor lesions and cancer in situ8.

However, the vaccination coverage in the target population of adolescents before their initial sexual contact since the implementation of vaccine in the larger population, with percentages below 80% among adolescents in specific territories. That is below the expected and recommended by the WHO for the first and second dose ensuring the herd effect (benefits of the application of vaccines received by uninoculated people)9.

Understanding the factors that affect the HPV vaccination decision-making is critical if health promotion interventions are to be developed and address doubts, myths and fears of acceptance in population groups least likely to receive the HPV vaccine9,10.

Factors affecting the adequate vaccination coverage in a given population are examined at different socio-territorial levels that include political, community, organization, interpersonal (parent-child relationship), and intrapersonal (professional) relations10. In a recent review, Ferrer et al.10, emphasized political factors, parents and guardians' decision, as well as the knowledge and counseling of health professionals as the main reasons in decision-making to obtain the vaccine for HPV. Still, these decisions are influenced by safety and efficacy of the vaccine; social norms and values related to sexual activity; confidence in vaccination programs and caregivers9,10. In our universal health system, individual financial limitations are not a significant influence in the decision-making since the vaccine is supplied to the target population without cost11.

In health facilities, health professionals' limited knowledge and skills in providing HPV vaccine could restrict a young woman's access to the vaccine regardless of her own beliefs and preferences12. Health professionals represent, in some studies, the main providers of advice on the vaccine. The relationship between the practitioner and the decision-maker requires clear, accessible and sometimes culturally appropriate communication and information about the HPV vaccination program12,13.

Parents may decide not to allow their daughters to be vaccinated, based on cultural or religious perceptions, and the unsubstantiated correlation of the vaccine facilitating early sexual activity12,13. Identification of HPV vaccine knowledge gaps and acceptance barriers among adolescents, parents/guardians and health professionals are necessary to develop targeted education programs for the lay population and continuing education in the work process of health professionals13,14.

Although young women are a critical part of the HPV vaccination program, the underrepresentation of their opinions in the qualitative literature should be considered in future research13. Health promotion activities should focus on the tripod of adolescents, parents/guardians and health care professionals to ensure adequate vaccine coverage and ensure the promising results of the vaccine.

The Journal of Human Grown Development (JHGD) brings the theme of health promotion in the scientific dissemination of articles and discusses necessary changes in the health-disease process, as in the study of Conception of the Right to Health of Mid-Level Technical Professionals of the Unified Health System In Brazil. The article reports on the biological model focused on the disease and medicalization as elements that still dominate in the Unified Health System policy15.

The permanent commitment of the journal JHGD to publish themes focused on healthy development inserted in the child and adolescent life cycle as the association of the prevalence of exposure to fluoride in the nails of children's hands with dental fluorosis16-18; between delayed neuropsychomotor development and infants of street drug users19 and the association of adequate growth with lipid profiles20.

The journal JHGD presents the importance of the concept of reproductive planning and preconception planning as a health promotion for children, as well as for the current situation of teenage pregnancy and the association with arterial hypertension21,22. Sexual and reproductive rights are considered in the cited article on the repercussions of Zika virus during pregnancy23. In the field of public health, the journal discloses the importance of identifying risk to provide quality care for chronic diseases24 and non-communicable diseases as well as the indiscriminate use of antibiotics25.

The perception and involvement of children and adolescents in clinical research, consent and assent and shared decision-making must be present in the development and planning of actions in health promotion for this population.

 

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15. Melo RMSB, Morais GB, Morais JB, Leite SN. Conception of the Right to Health of Mid-Level Technical Professionals of Unified Health System In Brazil. J Hum Growth Dev. 2018; 28(1):95-104. DOI: http://dx.doi.org/10.7322/jhgd.143886        [ Links ]

16. Leite JC, Neves JCJ, Vitor LGV, Fujisawa DS. Evaluation of postural control in children and adolescents with Down Syndrome aged eight to twelve years old. J Hum Growth Dev. 2018; 28(1):50-7. DOI: http://dx.doi.org/10.7322/jhgd.127335        [ Links ]

17. Bessa ARS, Dotto LMG, Cunha MA, Muniz PT, Cavalcante SO. Delivery and postpartum care in Rio Branco in the northern state of Acre, Brazil: a populationbased survey. J Hum Growth Dev. 2018; 28(1):69-76. DOI: http://dx.doi.org/10.7322/jhgd.118010        [ Links ]

18. Rigo L, Cericato GO, Sabadin CS, Solda C, Mário DN, Buzalaf MAR. Fingernails as a biomarker for dental fluorosis. J Hum Growth Dev. 2018; 28(1):82-8. DOI: http://dx.doi.org/10.7322/jhgd.133582        [ Links ]

19. Lima RE, Aleixo AA, Araújo LB, Nascimento CP, Azevedo VMGO. Neuropsychomotor development characteristics of the infants who born from women who abused drugs during pregnancy. J Hum Growth Dev. 2018; 28(1): 27-34. DOI: http://dx.doi.org/10.7322/jhgd.134374        [ Links ]

20. Guedes-Granzotti RB, Siqueira LS, Cesar CPHAR, Silva K, Domenis DR, Dornelas R, et al. Neuropsychomotor development and auditory skills in preschool children. J Hum Growth Dev. 2018; 28(1):35-41. DOI: http://dx.doi.org/10.7322/jhgd.123380        [ Links ]

21. Pinto VCM, Santos PGMD, Medeiros RCSC, Souza FES, Simões TBS, Dantas RPNC, et al. Maturational stages: comparison of growth and physical capacity indicators in adolescentes. J Hum Growth Dev. 2018; 28(1):42-9. DOI: http://dx.doi.org/10.7322/jhgd.127411        [ Links ]

22. Barreto GMS, Balbo SL, Rover MS, Toso BRGO, Oliveira HR, Viera CS. Growth and biochemical markers of newborn preterm up to six months of corrected age. J Hum Growth Dev. 2018; 28(1):18-26. DOI: http://dx.doi.org/10.7322/jhgd.138687        [ Links ]

23. Prata ARS, Pedroso D, Menezes G, Drezett J, Torres JHR, Bonfim JRA, et al. Juridical perspectives of interruption of pregnancy with zika virus infection regarding medical, emotional and social consequences. J Hum Growth Dev. 2018; 28(1): 77-81. DOI: http://dx.doi.org/10.7322/jhgd.143875        [ Links ]

24. Almeida RC, Zachêu PRZ, Diniz MT, Dias MCCPO, Guiguer IC, Almeida RC, Corrêa JA. Portuguese translation and Brazilian cultural adaptation of the Assessment of Burden in Chronic Venous Disease questionnaire (ABC-V) . J Hum Growth Dev. 2018; 28(1):89-94. DOI: http://dx.doi.org/10.7322/jhgd.143885        [ Links ]

25. Okasaki R, Carvalho WB, Ceccon MEJR. Newborns with staphylococcus aureus and coagulase-negative sepsis treated with vancomycin after an increase in serum levels in around the valley. J Hum Growth Dev. 2018; 28(1):9-17. DOI: http://dx.doi.org/10.7322/jhgd.143846        [ Links ]

 

 

Correspondence:
icesopreso@usp.br

Manuscript received: December 2017
Manuscript accepted: February 2018
Version of record online: March 2018

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