Sasidharanpillai Sabeena

The Impact of the COVID‐19 Pandemic on HPV Vaccination Coverage Among Adolescents From High‐Income Countries and Challenges: A Scoping Review

ABSTRACT Persistent high‐risk Human Papillomavirus (HPV) infection causes anogenital and oropharyngeal cancers across all genders. The primary cancer associated with HPV is cervical cancer and the HPV vaccination before sexual exposure is recommended for cervical cancer elimination globally. This scoping review aims to map the preliminary evidence regarding the determinants of adolescent HPV vaccine acceptance and hesitancy during the COVID‐19 pandemic in high income countries. A scoping review was conducted as per the updated Preferred Reporting Items for Systematic Reviews and Meta‐analyses extension for Scoping Reviews (PRISMA‐ScR) checklist. Using the PCC (Population, Concept, and Context) framework, search keywords and search strategies were developed. Electronic databases were searched using specific search terms and the last search date noted as February 8, 2025. A thematic content analysis was carried out to identify the themes and subthemes by a deductive approach. Fourteen studies were included as the potential sources of evidence in this review. The study population included 493,819 adolescents from Australia, Hong Kong, Italy, Poland, Saudi Arabia, and the USA. The themes identified were inequity, attitude and behaviour, knowledge and communication, and engagement and influence. The COVID‐19 pandemic generated a negative parental attitude towards HPV vaccines for a brief period. The adolescent HPV vaccine acceptance mainly depended on strong parental support and appropriate access to healthcare professionals and vaccination services. Travel restrictions, lockdowns, school closures, and social distancing contributed to significant HPV vaccine hesitancy in high income countries.

Human papillomavirus (HPV) DNA detection in uterine cervix cancer after radiation indicating recurrence: a systematic review and meta-analysis

The causal association of human papillomavirus (HPV) in uterine cervical cancer was well established and this oncogenic virus was reported to be a biomarker for overall recurrence and central pelvic recurrence. The objective of the present systematic review and meta-analysis was to assess the role of HPV DNA testing in early detection of recurrence among cervical cancer survivors after radiotherapy. We performed a systematic review and meta-analysis by means of searching electronic databases for published articles between January 1984 and June 2018, on the basis of standard systematic review guidelines prescribed by major agencies namely Cochrane Collaboration (https://www.cochrane.org) and Campbell Collaboration (https://www.campbellcollaboration.org). The meta-analysis component was further modified appropriately for the synthesis of sensitivity and specificity results. A total of 1,055 cervical cancer cases who had received pelvic radiation with or without chemotherapy from ten cohort studies were evaluated. The overall pooled sensitivity and specificity of HPV DNA testing was 0.84 (95% confidence interval [CI]= 0.66-0.94) and 0.35 (95% CI=0.20-0.54) respectively. The positive likelihood ratio was 1.3 (95% CI=1.0-1.7) and the negative likelihood ratio was 0.45 (95% CI=0.18-1.10) with an estimated diagnostic odds ratio of 3 (95% CI=1-9). The screening for HPV DNA testing during follow-up facilitates early detection of recurrence after radiotherapy.

Role of microRNAs in Predicting the Prognosis of Cervical Cancer Cases: A Systematic Review and Meta-Analysis

There is growing evidence for the possible use of microRNAs (miRNAs) in cancers as diagnostic as well as prognostic biomarkers in the present era of Personalized Medicine. The objective of the present systematic review and meta-analysis was to assess the prognostic role of microRNAs in uterine cervical cancers. A systematic review and meta-analysis was carried out searching electronic databases for published articles between January 2009 and August 2020 based on standard systematic review guidelines. Meta-analysis was performed by pooling the hazard ratio (HR) with 95% confidence interval (CI) to assess the prognostic value of deregulated miRNAs by the random-effects model. In the present meta-analysis, the aberrant expression of 14 microRNAs in 1,526 uterine cervical cancer cases before definitive therapy from 14 case-control studies were assessed. The pooled HR of two miRNAs, miRNA-155 and miRNA-224 which were upregulated in cervical cancer tissues was 1.76 (95% CI 1.27-2.45) revealing significant association with overall poor survival. Meanwhile, the pooled HR was 1.53 (95% CI 0.94-2.94) when all the deregulated miRNAs in cervical cancer tissues were evaluated. The pooled HR of downregulated miRNAs was 1.46 (95% CI 0.81, 2.64). Meanwhile, the pooled HR of three upregulated miRNAs-425-5p, 196a, 205 in the serum sample was 1.37 (95% CI 0.45 -4.20). The downregulation of aberrant miRNAs was not associated with poor overall survival rates.

Postvaccination prevalence of vaccine‐Human Papillomavirus (vHPV) genotypes among the target population: A systematic review and meta‐analysis

AbstractHuman Papillomavirus (HPV) vaccines are safe and are highly effective in reducing the prevalence of HPV infections and subsequent HPV associated diseases in the target population. A systematic review and meta‐analysis was carried out searching electronic databases for articles published between January 2007 and September 2020 reporting the prevalence estimates of vaccine HPV (vHPV) types in women who had received one or more doses of quadrivalent or bivalent vaccines. This systematic review was based on standard systematic review guidelines and the meta‐analysis was performed by pooling the HPV vaccine type prevalence data with 95% confidence interval (CI) among 16,929 young women who had received the prophylactic HPV vaccines before the age of 27 years. The overall pooled prevalence of vHPV types was.0.04 (95% CI: 0.02, 0.05). The meta‐analysis concludes that prophylactic HPV vaccination before the age of 27 years results in a decline of vHPV types in young women.

The Short-Term Impact Of COVID-19 Pandemic on Cervical Cancer Screening: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis were carried out to assess the pooled proportion of women screened for cervical cancer before and during the COVID-19 pandemic. After ruling out registered or ongoing systematic reviews in the PROSPERO database regarding the impact of the COVID-19 pandemic in cervical cancer screening, the protocol of our systematic review and meta-analysis was registered in PROSPERO (CRD42021279305). The electronic databases were searched for articles published in English between January 2020 and October 2021and the study was designed based on PRISMA guidelines updated in 2020. Meta-analysis was accomplished in STATA version 13.0 (College Station, Texas 77,845 USA). The pooled proportion of women who had undergone cervical cancer screening was reported with 95% CI. In order to quantify the heterogeneity, Chi2 statistic (Q statistic) and I2 index were used. The meta-analysis included seven studies from Slovenia, Italy, Ontario (Canada), Scotland, Belgium, and the USA, comprising 403,986 women and 199,165 women who were screened for cervical cancer before the COVID-19 pandemic in 2019 and during the pandemic in 2020, respectively. The pooled proportion of women screened for cervical cancer in 2019 was 9.79% (95% CI 6.00%-13.59%, 95% prediction interval 0.42%-23.81%). During the pandemic, the pooled proportion of screened women declined to 4.24% (95% CI 2.77%-5.71%, 95% prediction interval 0.9%-17.49%). There was a substantial drop in the cervical cancer screening rate due to lockdowns and travel restrictions to curb the COVID-19 pandemic. Scaling up cervical cancer screening strategies is essential to prevent the long-term impact of cervical cancer burden.

Implementation strategies of cervical cancer screening in South Asia: A systematic review

Abstract Background Cervical cancer is a preventable cancer by screening, vaccination and timely management of preinvasive cervical lesions. However, about 90% of the global burden of cervical cancer is reported from developing countries. Objective This systematic review aimed to analyze the strategies implemented for cervical cancer screening in South Asia. Search Strategy An electronic search of PubMed/MEDLINE, Scopus and Google Scholar was carried out for articles published in English, evaluating the implementation of cervical cancer screening between December 2000 and June 2023 in South Asia using appropriate search terms. Selection Criteria Cross‐sectional studies, randomized control trials (RCTs) or non‐randomized controlled trials evaluating different cervical screening strategies were included. Data Collection and Analysis A three‐stage selection process was performed using a validated proforma including the title, author, year of publication, objective, country, study design, screening methods, strategies and outcomes, and results. The systematic review was designed based on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. The risk of bias was evaluated with the National Heart, Lung, and Blood Institute's (NHLBI) Quality Assessment Tools. Main Results Out of the initial 1135 articles reviewed systematically, 23 studies met the inclusion criteria and were included in the qualitative synthesis of results. The implementation outcomes measured were acceptability ( n  = 23 100%), feasibility ( n  = 22, 95.7%), fidelity ( n  = 14, 60.9%), sustainability ( n  = 7, 30.4%), coverage ( n  = 4, 17.4%) and cost ( n  = 1, 4.3%). Conclusion Cervical cancer screening can be effectively implemented by restructuring the ongoing programs.