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Abstract
The FDA-approved vaccination against the Human Papillomavirus (HPV) was introduced in 2006, and since then, many countries have successfully implemented various HPV immunization programs. However, Pakistan, with approximately 73.8 million women at risk of cervical cancer, significantly lags behind, and currently, the HPV vaccination is not included in any immunization programs. This could be attributable to a dearth of awareness and knowledge amongst the masses regarding the HPV vaccine. The primary aim of this review was to evaluate public awareness and acceptance of the HPV vaccine in Pakistan. A literature search was conducted using electronic databases, including PubMed, Google Scholar, and ScienceDirect. Of the 222 studies in total, 15 were finalized, which met the review’s criteria and objectives. The review assessed the population’s awareness of the HPV vaccine's availability, their current vaccination status against HPV, and their willingness to get vaccinated against HPV. The analysis revealed that the current immunization status remains alarmingly low, which could be in line with low awareness regarding the availability of the HPV vaccine in Pakistan. There is a pressing need to introduce the HPV vaccination into the national immunization schedules and simultaneously strengthen regulatory frameworks surrounding the HPV vaccination in Pakistan.
Key words: Human Papillomavirus; HPV vaccine; Immunization programs; EPI; Pakistan
References
Markowitz LE, Tsu V, Deeks SL, Cubie H, Wang SA, Vicari AS, et al. Human papillomavirus vaccine introduction–the first five years. Vaccine. 2012 Nov 20; 30: F139-48. https://doi.org/10.1016/j.vaccine.2012.05.039
Centers for Disease Control and Prevention. Basic Information about HPV and Cancer. 2024 Sep 17.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021 May; 71(3): 209-49.https://doi.org/10.3322/caac.21660
Davies-Oliveira JC, Smith MA, Grover S, Canfell K, Crosbie EJ. Eliminating cervical cancer: progress and challenges for high-income countries. J Clin Oncol. 2021 Sep 1; 33(9): 550-9. https://doi.org/10.1016/j.clon.2021.06.013
Brisson M, Kim JJ, Canfell K, Drolet M, Gingras G, Burger EA, et al. Impact of HPV vaccination and cervical screening on cervical cancer elimination: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020 Feb 22; 395(10224): 575-90. https://doi.org/10.1016/S0140-6736(20)30068-4
Oncology TL. HPV vaccination in south Asia: new progress, old challenges. Lancet Oncol. 2022 Oct; 23(10): 1233. https://doi.org/10.1016/S1470-2045(22)00567-8
Dochez C, Al Awaidy S, Mohsni E, Fahmy K, Bouskraoui M. Strengthening national teams of experts to support HPV vaccine introduction in Eastern Mediterranean countries: Lessons learnt and recommendations from an international workshop. Vaccine. 2020 Jan 29; 38(5): 1114-9. https://doi.org/10.1016/j.vaccine.2019.11.027
HPV Information Centre. Pakistan Human Papillomavirus and Related Cancers, Fact Sheet. 2023 Oct 03.
Awan UA, Khattak AA. Has Pakistan failed to roll back HPV?. Lancet Oncol. 2022 May 1; 23(5): e204. https://doi.org/10.1016/S1470-2045(22)00141-3
World Health Organization. WHO updated recommendations on HPV vaccination schedule. 2022 Dec 20.
Kane MA, Sherris J, Coursaget P, Aguado T, Cutts F. HPV vaccine use in the developing world. Vaccine. 2006 Aug 21; 24: S132-9. https://doi.org/10.1016/j.vaccine.2006.05.128
Chan DN, Lee PP, So WK. Exploring the barriers and facilitators influencing human papillomavirus vaccination decisions among South Asian and Chinese mothers: a qualitative study. J Racial Ethn Health Disparities. 2024 Jun; 11(3): 1465-77. https://doi.org/10.1007/s40615-023-01623-4
Batool SA, Sajjad S, Malik H. Cervical cancer in Pakistan: A review. J Pak Med Assoc. 2017 Jul 1; 67(7): 1074-7.
Shamaun S, Jaleel R, Gull Y, Shahid A, Iqbal M, Qazi TN. Knowledge and attitude of cervical cancer screening and Vaccination in patients attending gynecology outpatient clinic at a tertiary care hospital in Pakistan. South Asian J Cancer. 2023 Jan; 12(01): 017-22. https://doi.org/10.1055/s-0042-1751093
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29; 372. https://doi.org/10.1136/bmj.n71
Shamsi U, Zahid F, Jabbar AB, Musharraf MD, Gauhar F, Akbar I,et al. Human papillomavirus vaccine awareness and acceptability for primary prevention of cervical Cancer in Pakistan: a cross-sectional study. Asian Pacific Journal of Cancer Prevention: APJCP. 2024;25(3):813. https://doi.org/10.31557/APJCP.2024.25.3.813
Kumari K, Shahid A, Farooqui A, Abbas K, Bashir F. Awareness of HPV Infection and its Relationship to Cervical Cancer in Medical Students of Karachi, Pakistan. AJSMU. 2022; 8(2): 74-9.
Ejaz M, Ekström AM, Ahmed A, Haroon A, Ali D, Ali TS, et al. Human Papillomavirus associated prevention: knowledge, attitudes, and perceived risks among men who have sex with men and transgender women in Pakistan: a qualitative study. BMC Public Health. 2022 Feb 22; 22(1): 378. https://doi.org/10.1186/s12889-022-12775-z
Ali RF, Arif Siddiqi D, Mirza A, Naz N, Abdullah S, Kembhavi G, et al. Adolescent girls’ recommendations for the design of a human papillomavirus vaccination program in sindh, Pakistan: a qualitative study. Hum Vaccin Immunother. 2022 Nov 30; 18(5): 2045856. https://doi.org/ 10.1080/21645515.2022.2045856
Khan M, Zafar A, Muneer R, Siddiqui A, Khan SA, Zafar A. Knowledge, Attitude and Practices Regarding Cervical Cancer and Human Papilloma Virus (HPV) Vaccination. PJMD. 2021; 10(2): 94-100. https://doi.org/ https://doi.org/10.36283/PJMD10-2/016
Zaidi TH, Zafar M, Memon S, Tufail M, Sattar A, Bajaj P, et al. Knowledge and practice of pap smear and vaccination regarding human papillomavirus among female medical students in Karachi, Pakistan. Health Scope J. 2021 Nov 30; 10(4). https://doi.org/ https://doi.org/10.5812/jhealthscope.119411
Safdar Z, Ashraf F, Bashir A. Awareness of human papilloma virus (HPV) vaccine female doctors working in tertiary care centres. TPMJ. 2021 Apr 10; 28(04): 464-9. https://doi.org/ https://doi.org/10.29309/TPMJ/2021.28.04.6067
Minhas S, Sajjad A, Kashif M, Rehman Z, Idrees M, Ansari F, et al. Cervical cancer vaccination awareness and acceptance among the females of Punjab, Pakistan. Makara J Health Res. 2020; 24: 48-56. https://doi.org/ 10.7454/msk.v24i1.1164
Riaz L, Manazir S, Jawed F, Ali SA, Riaz R. Knowledge, perception, and prevention practices related to human papillomavirus-based cervical cancer and its socioeconomic correlates among women in Karachi, Pakistan. Cureus. 2020 Mar; 12(3). https://doi.org/ 10.7759/cureus.7183
Sana Ghayas SG, Fakhsheena Anjum FA, Tazeen Husain TH, Lubna Bashir LB, Shazia Naz SN, Masood MA. Human papillomavirus and its vaccine: awareness and attitudes of young female Pakistani students. KMUJ. 2018 Dec 31; 10(4): 200-5. https://doi.org/ https://doi.org/10.35845/kmuj.2018.18405
Sohail I, Habib M, Khurshid N. Awareness and Knowledge of Human Papillomavirus and its Vaccine Amongst Doctors of Tertiary Care Hospital. JSOGP. 2018 Sep 6; 8(2): 110-4.
Ismail H, Rashid MN. The knowledge, attitudes and practices (KAP) regarding human papilloma virus (HPV) among women in Karachi, Pakistan. Am J Biomed Life Sci. 2017 Jul; 5(4): 69-72. https://doi.org/10.11648/j.ajbls.20170504.12
Zaheer R, Alam N, Faqir Hussain KC, Herekar AA, Nasir H, Bhutta SZ. Awareness about human papillomavirus as a cause of cervical cancer and its prevention in the undergraduate female students of Karachi. J Pak Med Assoc. 2017 Jan 1; 67(1): 27-32.
Khan TM, Buksh MA, Rehman IU, Saleem A. Knowledge, attitudes, and perception towards human papillomavirus among university students in Pakistan. Papillomavirus Res. 2016 Dec 1; 2: 122-7. https://doi.org/ 10.1016/j.pvr.2016.06.001
Gul S, Javed A, Mall S. Awareness about cervical cancer, human papilloma virus and acceptability of its vaccine among female university students of Peshawar Pakistan. Asian J Agri Biol. 2015; 3(3): 105-11.
Burney A, Zafar R. HPV vaccination as a mode of cervical cancer prevention in Pakistan. South Asian J Cancer. 2023 Jan; 12(01): 051-2. https://doi.org/ 10.1055/s-0043-1764211
Hwaid AH. Knowledge and awareness of papillomavirus and cervical cancer among college students and health care workers women in Diyala, Iraq. Am J Public Health Res. 2013; 1(8): 221-5. https://doi.org/ 10.12691/ajphr-1-8-5
Siddiqa A, Zainab M, Qadri I, Bhatti MF, Parish JL. Prevalence and genotyping of high risk human papillomavirus in cervical cancer samples from Punjab, Pakistan. Viruses. 2014 Jul 17; 6(7): 2762-77. https://doi.org/ 10.3390/v6072762
Khan S, Noonari AA, Zehra F, Yousaf W, ul Huda N, Qureshi A. Prevalence of HPV in Pakistani women. Pathology. 2016 Feb 1; 48: S133.
Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015 Feb 19; 372(8): 711-23. https://doi.org/ 10.1056/NEJMoa1405044
Castle PE, Maza M. Prophylactic HPV vaccination: past, present, and future. Epidemiol Infect. 2016 Feb; 144(3): 449-68. https://doi.org/ 10.1017/S0950268816000777
Shaikh MY, Hussaini MF, Narmeen M, Effendi R, Paryani NS, Ahmed A, et al. Knowledge, attitude, and barriers towards human papillomavirus (HPV) vaccination among youths of Karachi, Pakistan. Cureus. 2019 Nov; 11(11). https://doi.org/ 10.7759/cureus.6134
Ejaz M, Ekström AM, Ali TS, Salazar M, Ahmed A, Ali D, et al. Integration of human papillomavirus associated anal cancer screening into HIV care and treatment program in Pakistan: perceptions of policymakers, managers, and care providers. BMC Public Health. 2023 May 31; 23(1): 1034. https://doi.org/ https://doi.org/10.1186/s12889-023-15896-1
Khan AH, Niazi K, Abbas A, Gillani SN. Knowledge And Awareness Of Sexually Transmitted Diseases Among Men And Women Of Pakistan. JPSP. 2023 May 15: 1773-90.
Voo JY, Lean QY, Ming LC, Md. Hanafiah NH, Al-Worafi YM, Ibrahim B. Vaccine knowledge, awareness and hesitancy: A cross sectional survey among parents residing at Sandakan district, Sabah. Vaccines. 2021 Nov 17; 9(11): 1348. https://doi.org/10.3390/vaccines9111348
Perlman S, Wamai RG, Bain PA, Welty T, Welty E, Ogembo JG. Knowledge and awareness of HPV vaccine and acceptability to vaccinate in sub-Saharan Africa: a systematic review. PLoS One. 2014 Mar 11; 9(3): e90912. https://doi.org/10.1371/journal.pone.0090912
Omer SB, Orenstein WA, Koplan JP. Go big and go fast—vaccine refusal and disease eradication. N Engl J Med. 2013 Apr 11; 368(15): 1374-6. https://doi.org/ 10.1056/NEJMp1300765
Ortiz RR, Smith A, Coyne-Beasley T. A systematic literature review to examine the potential for social media to impact HPV vaccine uptake and awareness, knowledge, and attitudes about HPV and HPV vaccination. Hum Vaccin Immunother. 2019 Aug 3; 15(7-8): 1465-75. https://doi.org/ 10.1080/21645515.2019.1581543
Hakimi S, Lami F, Allahqoli L, Alkatout I. Barriers to the HPV vaccination program in the Eastern Mediterranean region: a narrative review. J Turk Ger Gynecol Assoc. 2023 Mar; 24(1): 48. https://doi.org/ 10.4274/jtgga.galenos.2022.2022-6-6
World Health Organization. Pakistan Expanded Programme on Immunization. 2024.
Business Recorder. Punjab to prepare vaccine to deal with cervical cancer challenge. 2024 Aug 22.
Tobaiqy M, MacLure K. A Systematic Review of Human Papillomavirus Vaccination Challenges and Strategies to Enhance Uptake. Vaccines. 2024 Jul 6; 12(7): 746.
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