Human Papilloma Virus and HPV vaccine knowledge among Mustafa Kemal University Medical Students

Transcription

1 Acta Medica Anatolia Volume 2 Issue Human Papilloma Virus and HPV vaccine knowledge among Mustafa Kemal University Medical Students Raziye Keskin Kurt 1, Atilla Karateke 1, Mehmet Erdem 2, Dilek Benk Silfeler 1, Ayse Nesrin Akkoca 3, Oya Soylu Karapinar 1, Ali Ulvi Hakverdi 1 1 Department of Obstetrics and Gynecology, Mustafa Kemal University Medical School, Hatay, Turkey 2 Department of Public Health, Mustafa Kemal University Medical School, Hatay, Turkey 3 Department of Family Medicine, Mustafa Kemal University Medical School, Hatay, Turkey Abstract Objectives: Human papilloma virus (HPV) is regarded as the main cause in the etiology of cervical cancer. The purpose of our study is to assess the knowledge of medical students about HPV vaccine and to evaluate their opinion on this subject. Methods: The study population consisted of 488 medical students. The survey was composed of questions intended to obtain information about transmission route of HPV, types of HPV, role of HPV in cervical cancer, whether HPV is treatable or not, which types of HPV the HPV vaccine prevents, the age groups HPV vaccine is administered, the opinions on HPV vaccine and sufficiency of public health, whether female students have underwent vaccination and if not what their drawbacks are. Results: Mean age of the students participating in the study was 21±4 and 58 % of the participants were female. Out of 448 medical students, 60% of them did not know that HPV was a sexually transmitted disease. Only 55% of the students knew about the association of HPV with cervical cancer and 52% of the participants stated that HPV vaccine could not be preventive against cervical cancer. None of female students had been immunized and 67% of female students did not consider getting immunized. Among those who did not consider getting immunized, 70% said they had worries about the safety of the vaccine. Conclusions: Our study results revealed that the knowledge of medical students about HPV is satisfactory, however their knowledge about HPV vaccine, immunization status and desire to be immunized were little. Keywords: Human papilloma virus, vaccine, cervical cancer Received: Accepted: Acta Medica Anatolia Introduction Cervical cancer ranks third after uterine and ovarian cancers among gynecological cancer diagnoses and deaths due to gynecological cancers in developed countries (1). Unfortunately, cervical cancer ranks second among all cancers most frequently noted and leading to death in women in under developed countries where screening and preventive programs for cervical cancer are not carried out. Eighty-six percent of cervical cancers are seen in developing countries. There has been a 75% decrease in the incidence and mortality of cervical cancer in developed countries due to screening programs and human papilloma virus vaccines for cervical cancer in the last 50 years (2).Human papilloma virus (HPV) is regarded as the main cause in the etiology of cervical cancer and is detected in 99.7% of cervical cancers (3). HPV is a sexually transmitted disease and among more than 40 genital mucosal HPVs, approximately 15 are known to be oncogenic. HPV 16 and 18 subtypes are found in cervical cancer in more than 70%. Most HPV infections are transient and are not sufficient to cause cervical neoplasms alone. Persistent oncogenic HPV causes cervical cancer. Figure-1: Knowledge of the students related to HPV and cervical cancer There is a mean duration of 15 years from the first infection to the development of invasive cancer. Recently, HPV vaccine has enabled primary prevention of cervical cancer. Two types of HPV vaccine have been developed as quadrivalent and bivalent. Quadrivalent vaccine is developed against HPV 6, 11, 16 and 18 and bivalent vaccine against HPV 16 and 18 (4, 5). Correspondence: Raziye Keskin Kurt MD, Mustafa Kemal University Medical School, Hatay, Turkey. 37 drraziyekeskinkurt@yahoo.com

2 Table-1: Baseline demographical properties of the study population. Age (mean±sd) 21±4 Male/Female (%) 58/42 Class distribution (%) Class-1 Class-2 Class-3 Class-4 Class-5 Class Marital status (Single, %) 100 Quadrivalent vaccine has been shown to be 97%- 100% effective in preventing more serious diseases due to cervical intraepithelial neoplasm (CIN) 2 and HPV in the population not infected with HPV (6). Bivalent vaccine has also been shown to be effective similar to the quadrivalent vaccine, at a rate of 93% (7). Effectivity of the vaccine decreases when it is administered to a population with prior HPV infection and it is emphasized that it should be applied before the onset of sexual activity. Although the American Cancer Society recommends routine vaccination of girls aged years, it can also be applied from age 9 to 26 (8). attention to it. The purpose of our study is to assess the knowledge of medical students about HPV vaccine and to evaluate their opinion on this subject. Materials and Methods A total of 488 medical students were included in our study and it was carried out between November 2013 and December 2013 at Mustafa Kemal University Medical Faculty. Previously prepared questionnaire forms were filled out by face to face interrogation with the individuals participating in the study. Survey forms were composed of questions prepared with the intention of evaluating the demographic characteristics and opinions and attitudes of participants about HPV and HPV vaccine. The survey was composed of questions intended to obtain information about transmission route of HPV, types of HPV, role of HPV in cervical cancer, whether HPV is treatable or not, which types of HPV the HPV vaccine prevents, the age groups HPV vaccine is administered, the opinions on HPV vaccine and sufficiency of public health, whether female students have underwent vaccination and if not what their drawbacks are. Statistics Continuous variables were represented as mean ± standard deviation (SD) and categorical variables were represented as percentage. Most of the results were presented as figures. Figure-3: Knowledge of the students related to HPV vaccine types Figure-2: Knowledge of the students related to HPV vaccine HPV vaccine has not yet entered the immunization program in our country. It is important to provide information about preventing cervical cancer and HPV vaccine to the current medical students who will provide health services in the future and draw their Results Mean age of the students participating in the study was 21±4 and 58 % (n=261) of the participants were female and 42 %( n=187) were male. All students were unmarried. Class distribution of the students is shown in Table 1. Out of 448 medical students, 60% of them did not know that HPV was a sexually transmitted disease. Only 55% of the students knew about the Acta Med Anatol 2014;2(2):

3 association of HPV with cervical cancer (figure-1). 60% of students thought that HPV was a treatable disease. 52% of the participants stated that HPV vaccine could not be preventive against cervical cancer (figure-2). 71% of the students did not know the types of HPV that the HPV vaccine was preventive against (figure-3). 88% of the students thought that HPV vaccine was administered after getting married. 98% of the participants thought that health care services about HPV vaccine were not adequate (figure-4) and 95% of the participants stated that they obtained knowledge about HPV vaccine in the lessons (figure-5). None of female students had been immunized and 67% of female students did not consider getting immunized (figure-6). Among those who did not consider getting immunized, 70% said they had worries about the safety of the vaccine. least one type of HPV during their lifetime (10). HPV increases with increased number of sexual partners and sexual activity in early age (11). Approximately 90% of HPV infections is transient and resolves spontaneously within 1-2 years without leaving a lesion (12). Immune system, genetic tendency, genetic variations within the HPV type, infection with more than one type of HPV may influence the persistence of HPV. Persistence of highly oncogenic HPV types is a risk factor for the formation of precursor lesions of cervical cancer (13). While there is a decrease in cancer incidence with the application of screening programs for cervical cancer in developed countries, the decrease is still not at the desired level in under developed countries. HPV vaccine is promising in the eradication of HPV associated diseases. Although HPV vaccine has provided a possibility of primary prevention from cervical cancer, studies have shown that the vaccine is not known sufficiently (14). Figure-4: Consideration of the students related to health care services Discussion With the advent of HPV vaccine, a possibility of eradicating cervical cancer has emerged. Unfortunately, a small portion of people are aware of this possibility and have not fully understood the efficient role of HPV in the prevention of cancer. As is known, the target of HPV vaccine is the young population and among these young people, the group that would be expected to have the most knowledge about HPV vaccine is the group of medical students. In addition, because every medical student will provide public health services in the future regardless of their specialty, they should have satisfactory knowledge about HPV vaccines regarding immunization and preventive medicine. The purpose of our study is to assess the knowledge and attitude of medical students about HPV vaccine. HPV can be transmitted either sexually or through genital skin contact. HPV which is associated with numerous morbidities and mortality is the leading sexually transmitted infection (9). It is estimated that 75% of sexually active adults will be infected with at Figure-5: HPV vaccines in the lessons. In a study by Durusoy et al. on 717 students who just started university, awareness of HPV vaccine and desire for immunization were assessed, and while 32.3% of students knew that HPV could lead to cervical cancer, 11.6% of female students desired to be immunized. Only 0.4% of the students had been immunized. Total knowledge score of the students was found to be low (15). In a study by Blödth et al. carried out on 504 students aged years in Germany, 67% of the students were immunized, and 80% of male students and 95% of female students knew that the vaccine was preventive against cervical cancer. On the other hand, knowledge about HPV was scarce and most did not know that HPV was a sexually transmitted disease (16). In our study, although the students were relatively aware of the association between HPV and cervical cancer, their knowledge about HPV and HPV vaccine was scarce. In the study by Ozyer et al. on 407 participants, only 1.4% of adolescents were found to be immunized with HPV vaccine (17). In the study by Laz et al. carried out Acta Med Anatol 2014;2(2):

4 by using the American national health questionnaire data, 12.7% of women aged years had completed the immunization program and 22% had undergone a single dose of the vaccine. Women without insurance and at low income level had a high risk of quitting the immunization program (18). In the study comprising 612 high school students aged years in Malaysia, 77.9% of the students were found to be immunized. The high rates of immunization have been attributed to the immunization program of the government applied to 13-year-old girls free of charge (19). Some studies have shown that acceptance rates of HPV vaccine increase when parents and young girls are well informed about the benefits and risks of the vaccine (20). Knowledge, safety, cost, parental limitation and efficiency of the vaccine have been shown to be effective in the acceptance of HPV vaccine (21, 22). In our study, most of the female students did not want to be immunized and they stated the reasons for this as insufficient knowledge about the vaccine and lack of knowledge about its safety. Rates of HPV immunization in our country are apparently rather low when compared with the data abroad. Figure-6: Consideration of the students for getting immunization Conclusion In conclusion, although the knowledge of medical students about HPV is satisfactory, it was seen that their knowledge about HPV vaccine, immunization status and desire to be immunized were little. Since increasing the awareness of people about HPV vaccine will be through informing the doctors and healthcare staff, education of medical students and doctors about HPV vaccination program should be emphasized. References 1. Siegel R, Naishadham D, Jemal A. Cancer statistics, CA Cancer J Clin Jan;63(1): Quinn M, Babb P, Jones J, Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ Apr 3;318(7188): Walboomers JM, Jacobs MV, Manos MM, Bosch FX, Kummer JA, Shah KV, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol Sep;189(1): A human papillomavirus vaccine. Med Lett Drugs Ther Aug 14-28;48( ): Cervarix--a second HPV vaccine. Med Lett Drugs Ther May 17;52(1338): Faeh D, William J, Yerly P, Paccaud F, Bovet P. Diabetes and pre-diabetes are associated with cardiovascular risk factors and carotid/femoral intima-media thickness independently of markers of insulin resistance and adiposity. Cardiovasc Diabetol. 2007;6: Paavonen J, Naud P, Salmeron J, Wheeler CM, Chow SN, Apter D, et al. Efficacy of human papillomavirus (HPV)- 16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet Jul 25;374(9686): Saslow D, Castle PE, Cox JT, Davey DD, Einstein MH, Ferris DG, et al. American Cancer Society Guideline for human papillomavirus (HPV) vaccine use to prevent cervical cancer and its precursors. CA Cancer J Clin Jan-Feb;57(1): Baseman JG, Koutsky LA. The epidemiology of human papillomavirus infections. J Clin Virol Mar;32 Suppl 1:S Koutsky LA, Galloway DA, Holmes KK. Epidemiology of genital human papillomavirus infection. Epidemiol Rev. 1988;10: Roset Bahmanyar E, Paavonen J, Naud P, Salmeron J, Chow SN, Apter D, et al. Prevalence and risk factors for cervical HPV infection and abnormalities in young adult women at enrolment in the multinational PATRICIA trial. Gynecol Oncol Dec;127(3): Rodriguez AC, Schiffman M, Herrero R, Wacholder S, Hildesheim A, Castle PE, et al. Rapid clearance of human papillomavirus and implications for clinical focus on persistent infections. J Natl Cancer Inst Apr 2;100(7): Trottier H, Franco EL. The epidemiology of genital human papillomavirus infection. Vaccine Mar 30;24 Suppl 1:S Klug SJ, Hukelmann M, Blettner M. Knowledge about infection with human papillomavirus: a systematic review. Prev Med Feb;46(2): Durusoy R, Yamazhan M, Tasbakan MI, Ergin I, Aysin M, Pullukcu H, et al. HPV vaccine awareness and willingness of Acta Med Anatol 2014;2(2):

5 first-year students entering university in Western Turkey. Asian Pac J Cancer Prev. 2010;11(6): Blodt S, Holmberg C, Muller-Nordhorn J, Rieckmann N. Human Papillomavirus awareness, knowledge and vaccine acceptance: a survey among year old male and female vocational school students in Berlin, Germany. Eur J Public Health Dec;22(6): Ozyer S, Uzunlar O, Ozler S, Kaymak O, Baser E, Gungor T, et al. Awareness of Turkish female adolescents and young women about HPV and their attitudes towards HPV vaccination. Asian Pac J Cancer Prev. 2013;14(8): Laz TH, Rahman M, Berenson AB. Human papillomavirus vaccine uptake among 18- to 26-year-old women in the United States: National Health Interview Survey, Cancer Apr 1;119(7): Al-Naggar RA, Bobryshev YV, Al-Jashamy K, Al-Musli M. Practice of HPV vaccine and associated factors among school girls in Melaka, Malaysia. Asian Pac J Cancer Prev. 2012;13(8): Kahn JA, Rosenthal SL, Hamann T, Bernstein DI. Attitudes about human papillomavirus vaccine in young women. Int J STD AIDS May;14(5): Chan ZC, Chan TS, Ng KK, Wong ML. A systematic review of literature about women's knowledge and attitudes toward human papillomavirus (HPV) vaccination. Public Health Nurs Nov;29(6): Blackman E, Thurman N, Halliday D, Butler R, Francis D, Joseph M, et al. Multicenter study of human papillomavirus and the human papillomavirus vaccine: knowledge and attitudes among people of African descent. Infect Dis Obstet Gynecol. 2013;2013: Acta Med Anatol 2014;2(2):