|Year : 2022 | Volume
| Issue : 3 | Page : 220-226
Awareness and knowledge regarding human papilloma virus vaccine among medical students
Mannava Sai Priya, Atchyuta Mathi, Renuka Inuganti
Department of Pathology, NRI Medical College, Chinakakani, Guntur, Andhra Pradesh, India
|Date of Submission||11-Jul-2022|
|Date of Acceptance||16-Jul-2022|
|Date of Web Publication||26-Dec-2022|
Dr. Atchyuta Mathi
Department of Pathology, NRI Medical College, Chinakakani, Guntur, Andhra Pradesh - 522003
Source of Support: None, Conflict of Interest: None
Context: Cervical cancer is the commonest type of cancer in females worldwide and can lead to mortality in some of the cases. Most cases of cervical carcinomas are due to infection by Human Papilloma Virus types 16 and 18. Cervical carcinomas can be prevented by vaccination against HPV as HPV is the commonest risk factor that can be prevented. Despite the availability of vaccine, its existence is hardly known and is seldom used due to lack of awareness. Hence this study is being undertaken to assess the awareness amongst medical students.
Aim: To analyze the knowledge of medical students about the availability and acceptance of HPV vaccination against cervical cancer
Settings and Design: It is an observational descriptive study done after taking the informed consent from all the undergraduate medical students in our institute.
Methods and Material: The study was done on all the undergraduate medical students by providing a preformed questionnaire, regarding HPV vaccination.
Statistical Analysis: The results were entered into a Microsoft excel sheet. Standard error of difference between proportions is applied to know the significance of difference in results between the variables.
Results: The results will help in assessing the need for awareness programs among the medical students
Conclusions: As prevention is better can cure, awareness about the HPV vaccine among the medical students, will definitively help to prevent cervical cancer.
Keywords: Awareness, human papilloma virus, vaccination
|How to cite this article:|
Priya MS, Mathi A, Inuganti R. Awareness and knowledge regarding human papilloma virus vaccine among medical students. J NTR Univ Health Sci 2022;11:220-6
|How to cite this URL:|
Priya MS, Mathi A, Inuganti R. Awareness and knowledge regarding human papilloma virus vaccine among medical students. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Feb 7];11:220-6. Available from: https://www.jdrntruhs.org/text.asp?2022/11/3/220/365010
| Introduction|| |
Cervical cancer is the fourth most common type of cancer in females worldwide and every year several hundred thousand women die because of this disease, mainly in developing countries., There has been definitive evidence to show that 70% to 80% cases of cervical cancers are due to persistent infection by sexually transmitted Human Papilloma Virus (HPV) types 16 and 18., Vaccination against HPV is also an important mode of primary prevention against cervical cancer as it is one of those risk factors that can be prevented.
The primary modes of transmission of HPV infection are skin-to-skin or skin-to-mucosa contact. Some HPV types mainly infect cutaneous tissues and induce warts, while other HPV types mainly target mucosal tissues of cervical and oral tracts.,, There are more than 100 types of HPV, of which at least 14 are cancer-causing [also known as high-risk type]. HPV type 16 and HPV type 18 cause 70% precancerous and cancerous lesions of the cervix. This virus might also cause other anogenital cancers and many health problems in both genders.
HPV vaccination is of major public health importance. Indian Academy of Pediatrics and Federation of Obstetric and Gynecological Societies of India recommend the HPV vaccine to all women who can afford the vaccine.
Two vaccines Gardasil and Cervarix, are available in India. Gardasil quadrivalent vaccine protects against HPV 16, HPV 18, HPV 6, and HPV 11. Cervarix is a bivalent vaccine and protects against HPV 16 and HPV 18. Cervarix induces high anti-HPV16 and 18 antibody titers and can prevent the incidence of infection for at least 10 years.,, In addition, Cervarix invokes a significantly high and long-term cross-reactive immunogenicity against
HPV31 and 45. Quadrivalent Gardasil shows excellent efficacy against cervical HPV infection, cervical cancer precursor lesions, and genital warts caused by the HPV types covered by Gardasil.,, In addition, studies demonstrated that Gardasil significantly decreases HPV infections in the anus, vulva, and penis, and oral cavity related to HPV vaccine types.,, Despite, the availability of vaccine, its existence is hardly known and is seldom used by the public due to lack of awareness. To create awareness, it is a must for the medical personnel to have knowledge about the vaccines, so that they can in turn spread the awareness to a wide range of population. The medical students, who will be the future practicing doctors, play a very important role in spreading this awareness among the public, so that this health program is successful.
The aim of the study is to analyze the knowledge of medical students regarding the availability and acceptance of the vaccines against cervical cancer and also to educate those students who are unaware.
The objectives include testing the knowledge of Medical students about HPV vaccination in prevention of cervical cancers and to create awareness among them, so that they aid in spreading knowledge to the general public, thereby contributing to prevention of cervical cancers.
| Subjects and Methods|| |
The study was an observational descriptive study carried out from August to September 2021 at our institution after getting the approval from the Institutional ethics committee. A total of 550 students who are pursuing MBBS first, second, final year part 1, and final year part 2 were taken as the study population, which included 359 female, 191 male students in the age groups of 18--25 years.
The study was conducted after obtaining the consent from participants. Those students who did not give consent were excluded from the study. The students were assured of confidentiality of the information. They were given a pre formed questionnaire and were instructed to tick the appropriate answer in the questionnaire given and to fill in the blanks in the space provided to them. No time limit was given.
The sheets were then collected, and the results were entered into a Microsoft excel sheet.
Chi square test was applied to know the association between the gender and level of knowledge.
P value less than or equal to 0.05 was taken as statistically significant.
The questionnaire included the following parameters
- General information about the study population such as: age, gender, and marital status.
- Knowledge regarding HPV infection in the form of awareness about human papillomavirus, modes of transmission of HPV, awareness regarding human papillomavirus causing genital and anal warts and cancer in women and men and various carcinogenic strains of HPV.
- Knowledge and awareness regarding HPV vaccination in the form of the availability of the vaccines, Can the vaccine be given to sexually active women etc.
| Results|| |
The results of the data collected through questionnaires were entered in Microsoft excel sheet, tabulated, and analyzed. Chi square test was applied to know the association between the gender and level of knowledge.
550 students participated in the study. Among these 359 were females students and 191 were males students. The general information regarding gender and categorization based on the year of studying MBBS are shown in [Table 1]. The age range of all the students who participated in the study was between 18 and 25 years and all of them were unmarried.
The responses obtained from the questionnaires regarding the knowledge of HPV infection were tabulated under [Table 2].
Knowledge regarding HPV infection
The results showed that 99.3% of all the students were aware of HPV, 87.6% of the students were aware about the modes of transmission of HPV. 98.2% of the students were aware that HPV causes genital and anal warts and cancer in women and men. 73.3% of the students were aware about the carcinogenic strains of HPV. There was no significant difference between males and females students regarding the awareness of human papilloma virus and about its causation of genital, anal warts and cancer with P value > 0.05.
Regarding the knowledge about the modes of transmission of HPV and about carcinogenic strains of HPV, female students were more aware when compared to male students with P value of 0.01 and 0.001, respectively.
The responses obtained through the questionnaires about the Knowledge and awareness regarding HPV vaccination was tabulated under [Table 3].
Knowledge and awareness regarding HPV vaccination
The results showed that 88.5% of all the students were aware of the availability of HPV vaccination, 78% of all the students were aware that the HPV vaccine could be given to sexually active women. 94% of all the students accepted to use the vaccine to counteract some strains of HPV. 98.1% of female medical students were willing are HPV vaccine and only 86.4% of male medical students were willing with a statistically significant P value of 0.00001.
Half of the total students (56.4%) were aware of the availability of vaccination even for men and about the protection of HPV vaccination in already HPV infected women.
Only 5.3% of the students knew about the age group for vaccination and 44.9% of all the students were aware about the strains of HPV against which the vaccination protects.
There is no significant difference between male and female students regarding the availability of HPV vaccination, its usage in sexually active women, acceptance of vaccination, availability of HPV vaccination for males, its protection among already HPV infected women and about the strains against which the vaccine can offer protection.
Significant difference was observed between male and female students about the age eligibility for HPV vaccination with a P value of 0.0012.
Most of the students wanted to take the vaccine to protect themselves and the percentages are displayed in chart: 1. The reasons for not accepting the vaccine among the students are shown in chart: 2. Chart 3 shows what the students want to know before getting the vaccine. Chart 4 displays the reasons that are stopping the students from getting the vaccination and chart 5 shows what factors can make them more likely to get vaccinated.
Chart: 1: Percentage distribution of the students to the reason for accepting to use the vaccine:
- To protect myself from disease.
- To protect my sexual partners from disease.
- To help reduce cancer in women and men.
Chart: 2: Percentage distribution of the students for not accepting to use the vaccine
- I do not need it.
- It may not be safe.
- My friends and/or family would not approve of its use.
- Other (specify).
Chart: 3: Percentage distribution of students about what they want to know before the vaccine
- Regarding the safety.
- No. of doses.
- Efficiency of vaccine.
- Side effects.
- If other people are getting the vaccine.
Chart: 4: Percentage distribution of students regarding what stops them from getting the HPV vaccine
- Lack of knowledge.
- Fear of needles.
- Fear of vaccines, side effects, cost, transportation to the clinic is difficult.
- Time away from work or school to get the vaccines.
Chart: 5: Percentage distribution of students about what factors would ensure more vaccination
- Complete awareness about the vaccine.
- If your doctor recommends it.
- If it is free or paid by insurance.
- If your sexual partner wants you to get it.
- If the government approves it.
| Discussion|| |
The study participants included all the undergraduates' medical students of our medical school, and the percentage of female students that participated in the study was more than those reported in the studies done by Snigdha Kamini et al. and Nagasireesha Challa et al. and are presented in [Table 4]. This may be because these studies were conducted in different study areas. In the present study, the majority of the students were aware of HPV (99.3%) similar to the studies done by Snigdha Kamini et al. [97.1%] and by Sumita Mehta et al [90%]. In contrast, awareness regarding HPV was very low in the study done by Alyse Reichheld et al. and this is because the study was done on urban women. The awareness regarding modes of transmission of HPV was more in the present study (87.6%) when compared to the study done by Snigdha Kamini et al. (79.3%) and by Nagasireesha Challa et al. (81.1%)
The awareness regarding the availability of vaccines is less in this study (88.5%) compared to the results reported in the study by Nagasireesha Challa et al (90.5%) and more when compared to studies done by Snigdha Kamini et al. (50.4%). Acceptance of vaccine is high in this study is 94% where as it was 64.9% and 80.3% in the study done by Snigdha Kamini et al. and by Nagasireesha Challa et al. Awareness about the availability of vaccines for males is more [56.4%] when compared to the results reported in the study by Nagasireesha Challa et al. [47.2%]. Knowledge regarding the age group of vaccination is much less [5.3%] than the results reported by Snigdha Kamini et al. [79%]. This could be due to the difference in study subjects as Snigdha Kamini et al. study included only final year part 1 and final year part 2 medical students. With increase in the study year, the knowledge has been increasing, indicating that the study curriculum also plays a pivotal role in creating awareness which can help in spreading the knowledge to the general population.
In a cross-sectional study by Sumita Mehta et al., the results showed that there is a low level of awareness regarding HPV [90%] and the HPV vaccine [82%]. This is contrary to the results obtained in our study that 99.3% students were well aware of HPV and its infection; 88.5% were aware regarding vaccination. Only 88% of the females intended to take the vaccine according to the research by Sumita Mehta et al. and it was 98% in our study.
In a cross-sectional study that was done in women in the urban community in South India by Alyse Reichheld et al., it was reported that almost 85% of the women surveyed had poor knowledge of cervical cancer; no women knew about the availability of vaccination. This shows the difference between the women in urban general population and women medical students and indicates that there is better knowledge among medical students when compared to the general population stressing that increasing the knowledge among medical students will help in spreading that information to general public.
Further, in the present study it was evident that a greater percentage of students (32.7%) said lack of knowledge is preventing them from getting the HPV vaccine. The fear for vaccine and cost of the vaccine are also the reasons for not taking the vaccine as shown in chart 4. It was also clear that 47.5% of the medical students would like to have complete awareness about the vaccine before vaccinated and is displayed in chart 5. The vaccine provided by the government and doctors recommending to take the vaccine can increase the vaccination rate.
| Conclusion|| |
This study shows that a greater percentage of students have better knowledge regarding HPV infection. Regarding knowledge of HPV vaccination, a less percentage of students have complete awareness regarding HPV vaccination. Less than 10% of students were aware of the age group of vaccination. So, in order to bridge this gap, with the help of the Gynecology department, a batch wise awareness program was conducted for the medical students to create awareness regarding cervical cancer vaccination. Further, this study can also help us to create awareness among the males, so that vaccination for males can also prevent them against genital warts and their partners from cervical cancers. The knowledge imparted subsequently to the students included:
- The ideal age group for HPV vaccination was in the age group of 9--13 years and should be given as two doses of vaccination in a gap of six months. Three doses of vaccination at a schedule of 0, 1, and 6 months for women aged 14--45 years who have not previously completed vaccination.
- The cost of each vaccine (Rupees 3500--4500).
- There are no post vaccination side effects
- Efficacy of HPV vaccination to prevent cervical cancer due to HPV is almost 100%,
provided they are not infected prior.
To conclude, by increasing the knowledge and conducting a teaching program in medical students regarding HPV vaccination, awareness among the general public can be achieved.
We sincerely acknowledge ICMR for accepting and approving in Indian Council Of Medical Research Short Term Studentship, 2020 with Reference ID: 2020-07565
Ethical committee approval was obtained from institutional ethical committee.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bruni L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, et al
. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. HPV Information Center, Summary Report. 2019. www.hpvcentre.net.
Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al
. Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis. Lancet Glob Health 2020;8:e191-203.
Castellsagué X. Natural history and epidemiology of HPV infection and cervical cancer. Gynecol Oncol 2008;110:S4-7.
Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet 2007;370:890-907.
Thun MJ, DeLancey JO, Center MM, Jemal A, Ward EM. The global burden of cancer: Priorities for prevention. Carcinogenesis 2010;31:100-10.
Cheng L, Wang Y, Du J. Human papillomavirus vaccines: An updated review. Vaccines (Basel) 2020;8:391.
Brianti P, De Flammineis E, Mercuri SR. Review of HPV-related diseases and cancers. New Microbiol 2017;40:80-5.
Athanasiou A, Bowden S, Paraskevaidi M, Fotopoulou C, Martin-Hirsch P, Paraskevaidis E, et al
. HPV vaccination and cancer prevention. Best Pract Res Clin Obstet Gynaecol 2020;65:109-24.
Indian Academy of Pediatrics Committee on Immunization IAPCOI. Consensus recommendations on immunization, 2008. Indian Pediatr 2008;45:635-48. PMID: 18723905.
Malagón T, Drolet M, Boily MC, Franco EL, Jit M, Brisson J, et al
. Cross-protective efficacy of two human papillomavirus vaccines: A systematic review and meta-analysis. Lancet Infect Dis 2012;12:781-9.
Schwarz TF, Huang LM, Valencia A, Panzer F, Chiu CH, Decreux A, et al
. A ten-year study of immunogenicity and safety of the AS04-HPV-16/18 vaccine in adolescent girls aged 10-14 years. Hum Vaccin Immunother 2019;15:1970-9.
Garland SM, Kjaer SK, Muñoz N, Block SL, Brown DR, DiNubile MJ, et al
. Impact and Effectiveness of the quadrivalent human papillomavirus vaccine: A systematic review of 10 years of real-world experience. Clin Infect Dis 2016;63:519-27.
Giuliano AR, Palefsky JM, Goldstone S, Moreira ED Jr, Penny ME, Aranda C, et al
. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med 2011;364:401-11.
Schlecht NF, Masika M, Diaz A, Nucci-Sack A, Salandy A, Pickering S, et al
. Risk of oral human papillomavirus infection among sexually active female adolescents receiving the quadrivalent vaccine. JAMA Netw Open 2019;2:e1914031.
Wilkin TJ, Chen H, Cespedes MS, Leon-Cruz JT, Godfrey C, Chiao EY, et al
. A randomized, placebo-controlled trial of the quadrivalent human papillomavirus vaccine in human immunodeficiency virus-infected adults aged 27 years or older: AIDS clinical trials group protocol A5298. Clin Infect Dis 2018;67:1339-46.
Kamini S, Bhimarasetty DM. Awareness about human papilloma virus vaccine among medical students. Asian J Med Sci 2016;7:64-7.
Challa N, Madras V, Challa S. Awareness and attitude regarding human papilloma virus and its vaccine among medical students in a medical school in India. Int J Res Med Sci 2014;2:1607-11.
Mehta S, Rajaram S, Goel G, Goel N. Awareness about Human Papilloma Virus and its Vaccine Among Medical Students. Indian J Community Med 2013;38:92-4.
] [Full text]
Reichheld A, Mukherjee PK, Rahman SM, David KV, Pricilla RA. Prevalence of cervical cancer screening and awareness among women in an urban community in South India—A cross sectional study. Ann Glob Health 2020;86:30.
[Table 1], [Table 2], [Table 3], [Table 4]