Controversy still exists over whether the benefits of the available HPV vaccines outweigh the risks and this has suppressed uptake of the HPV vaccines in comparison to other vaccines. Concerns about HPV vaccine safety have led some physicians, healthcare officials and parents to withhold the recommended vaccination from the target population. The most common reason for not administering the prophylactic HPV vaccines are concerns over adverse effects. The aim of this review is the assessment of peer-reviewed scientific data related to measurable outcomes from the use of HPV vaccines throughout the world with focused attention on the potential adverse effects. We found that the majority of studies continue to suggest a positive risk-benefit from vaccination against HPV, with minimal documented adverse effects, which is consistent with other vaccines. However, much of the published scientific data regarding the safety of HPV vaccines appears to originate from within the financially competitive HPV vaccine market. We advocate a more independent monitoring system for vaccine immunogenicity and adverse effects to address potential conflicts of interest with regular systematic literature reviews by qualified individuals to vigilantly assess and communicate adverse effects associated with HPV vaccination. Finally, our evaluation suggests that an expanded use of HPV vaccine into more diverse populations, particularly those living in low-resource settings, would provide numerous health and social benefits.
IntroductionCervical self-collection is a safe and efficient method for detecting sexually transmitted infections (STIs). The study aims to verify the acceptance of cervical self-collection and the prevalence of HPV, HHV-2 and HIV-1 infection in women living in the Tapajós region, Amazônia, Brazil.MethodsCross-sectional study with women attending in Santarém-Pará. The collection was performed between August 2015 and January 2017. Participants collected cervical scrapings and peripheral blood. Those who accepted, also performed cervical self-collection. Detection of HPV DNA was performed by nestedPCR with MY09/11 and GP5/6+ primers and typing was done by sequencing. Detection of HHV-2 DNA was performed by real-time PCR with Taqman. Identification of anti-HIV-1/2 antibodies was made by Alere Determine Kit.ResultsA total of 206 specimens were obtained from 112 women. The acceptance of cervical self-collection was 84% (94/112) and HPV DNA was identified in 39.4% (37/94) of the samples. While the prevalence of HPV infection in cervical scraping was 32.1% (36/112). All the women presented Papanicolaou negative for malignancy. The most prevalent types were HPV-16 and HPV-18. The overall prevalence of HHV-2 infection was 8.9%. The concordance rate in the molecular diagnosis between cervical scraping and cervical self-collection was 65% (26/40) for HPV and 50% (4/8) for HHV-2. No woman had HIV-1 reactive serology.ConclusionA high prevalence of HPV infection was found in women without dysplastic lesion. Cervical self-collection had high acceptance, moderate concordance rate in the detection of HPV DNA compared to cervical scraping, and alone it was more efficient in the detection of HPV. This is the first study in women living in Tapajós region and the findings strongly suggest that cervical self-collection may be a useful tool for increasing access to diagnosis of STIs and screening for cervical cancer in women living in the Amazon.
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