Hepatitis: Markowitz LE

Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER, Anonymous00118, Anonymous00119. · Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (proposed), Atlanta, GA 30333, USA. · MMWR Recomm Rep. · Pubmed #17380109 links to  free full text

Abstract: These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of a quadrivalent human papillomavirus (HPV) vaccine licensed by the U.S. Food and Drug Administration on June 8, 2006. This report summarizes the epidemiology of HPV and associated diseases, describes the licensed HPV vaccine, and provides recommendations for its use for vaccination among females aged 9-26 years in the United States. Genital HPV is the most common sexually transmitted infection in the United States; an estimated 6.2 million persons are newly infected every year. Although the majority of infections cause no clinical symptoms and are self-limited, persistent infection with oncogenic types can cause cervical cancer in women. HPV infection also is the cause of genital warts and is associated with other anogenital cancers. Cervical cancer rates have decreased in the United States because of widespread use of Papanicolaou testing, which can detect precancerous lesions of the cervix before they develop into cancer; nevertheless, during 2007, an estimated 11,100 new cases will be diagnosed and approximately 3,700 women will die from cervical cancer. In certain countries where cervical cancer screening is not routine, cervical cancer is a common cancer in women. The licensed HPV vaccine is composed of the HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein in yeast using recombinant DNA technology produces noninfectious virus-like particles (VLP) that resemble HPV virions. The quadrivalent HPV vaccine is a mixture of four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18 combined with an aluminum adjuvant. Clinical trials indicate that the vaccine has high efficacy in preventing persistent HPV infection, cervical cancer precursor lesions, vaginal and vulvar cancer precursor lesions, and genital warts caused by HPV types 6, 11, 16, or 18 among females who have not already been infected with the respective HPV type. No evidence exists of protection against disease caused by HPV types with which females are infected at the time of vaccination. However, females infected with one or more vaccine HPV types before vaccination would be protected against disease caused by the other vaccine HPV types. The vaccine is administered by intramuscular injection, and the recommended schedule is a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of females is 11-12 years. Vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13--26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended.

Dunne EF, Markowitz LE. · Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Clin Infect Dis. · Pubmed #16886157 No free full text.

Abstract: Over the past few decades, epidemiology and natural history studies have led to improved understanding of human papillomavirus (HPV) infection and to promising prevention strategies. HPV infection is the cause of anogenital warts and cervical cancer, as well as a proportion of other anogenital and head and neck cancers. Data from clinical trials have resulted in recommendations that support the use of an HPV test in the context of cervical cancer screening and management. Prophylactic HPV vaccine trials have demonstrated high efficacy, and an HPV vaccine that prevents cervical cancer precursors, cervical cancer, and anogenital warts caused by HPV types 6, 11, 16, and 18 was licensed for use in girls and women aged 9-26 years by the US Food and Drug Administration (FDA) in June 2006. In this article, we review genital HPV for the clinician, with a primary focus on the prevalence of HPV infection in the United States.

Chesson HW, Forhan SE, Gottlieb SL, Markowitz LE. · Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. · Vaccine. · Pubmed #18598734 No free full text.

Abstract: We estimated the health and economic benefits of preventing recurrent respiratory papillomatosis (RRP) through quadrivalent human papillomavirus (HPV) vaccination. We applied a simple mathematical model to estimate the averted costs and quality-adjusted life years (QALYs) saved by preventing RRP in children whose mothers had been vaccinated at age 12 years. Under base case assumptions, the prevention of RRP would avert an estimated USD 31 (range: USD 2-178) in medical costs (2006 US dollars) and save 0.00016 QALYs (range: 0.00001-0.00152) per 12-year-old girl vaccinated. Including the benefits of RRP reduced the estimated cost per QALY gained by HPV vaccination by roughly 14-21% in the base case and by <2% to >100% in the sensitivity analyses. More precise estimates of the incidence of RRP are needed, however, to quantify this impact more reliably.

Dinh TH, Sternberg M, Dunne EF, Markowitz LE. · Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Sex Transm Dis. · Pubmed #18360316 No free full text.

Abstract: BACKGROUND: Genital warts are caused by human papillomavirus (HPV); over 90% are due to HPV types 6 and 11. We determined the percentage of persons who reported having been diagnosed with genital warts in the United States from 1999--2004. METHODS: We collected genital wart diagnosis history and sociodemographic and sexual behavior data from 8849 sexually active men and women aged 18 to 59 years as part of the National Health and Nutrition Examination Survey, 1999--2004. RESULTS: Overall, 5.6% of 18-to 59-year olds reported having ever been diagnosed with genital warts. The percentage was higher in women (7.2%, 95% CI, 6.2%-8.4%) than in men (4%, 95% CI, 3.2%-5.0%). History of genital wart diagnosis peaked among 25- to 34-year-old women (10.4%) and 35- to 44-year-old men (6.0%). Sex, age, race/ethnicity, number of lifetime sex partners, and cocaine/street drug use were associated with genital warts in multivariate analysis. CONCLUSIONS: These are the first national data on the burden of genital warts in the United States. The substantial burden of genital warts could be reduced by a prophylactic HPV vaccine to types 6 and 11.

Dinh TH, Dunne EF, Markowitz LE, Weinstock H, Berman S. · Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Center for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Sex Transm Dis. · Pubmed #18157062 No free full text.

Abstract: OBJECTIVES: We describe neonatal herpes reporting and the number of cases reported in states with reporting requirements in the United States, 2000-2005. METHODS: A national assessment of neonatal herpes reporting practices was conducted using an e-mail and phone query. RESULTS: Neonatal herpes was a reportable condition in 9 states in the United States from 2000-2005: CT, MA, FL, OH, NE, LA, SD, DE, and WA. There was no standard surveillance case definition in 5 states and in 4 states there was no specific form for reporting neonatal herpes. Few cases were reported in any state (range, 0-13 cases per year). A total of 112 cases were reported in these 9 states over 5 years (2000-2004); the overall incidence rate was 4 cases/100,000 live births. CONCLUSIONS: Although reportable in some states, neonatal herpes is not currently a nationally reportable disease. As currently employed by individual states during this time frame, neonatal herpes reporting does not appear to be a reliable way to assess burden of disease. Development of a standard case definition and assessment of the best approaches for local and national neonatal herpes surveillance may improve performance of such reporting.

Hariri S, Dunne EF, Sternberg M, Unger ER, Meadows KS, Karem KL, Markowitz LE. · National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Sex Transm Dis. · Pubmed #18091027 No free full text.

Abstract: OBJECTIVES: The national seroprevalence of the nononcogenic human papillomavirus (HPV) type 11, one of the types targeted by the quadrivalent HPV vaccine, has not been evaluated in the United States. The objectives of this study were to estimate the national seroprevalence and evaluate predictors of HPV-11 seropositivity. STUDY DESIGN: We tested serum samples for HPV-11 antibodies and analyzed questionnaire data from the second phase of the National Health and Nutrition Examination Survey III, 1991--1994. Seroprevalence estimates were weighted to represent the US population. RESULTS:: Overall seroprevalence of HPV-11 infection was 4.7%. Seroprevalence was significantly higher among females (5.7%) than among males (3.6%). Independent predictors of HPV-11 seropositivity included sex, race/ethnicity, lifetime number of sex partners, education, and HPV-16 seropositivity. CONCLUSION: This study represents the most comprehensive picture of HPV-11 infection in the United States to date, and provides baseline data on the prevalence of HPV-11 before availability of the quadrivalent HPV vaccine.

Weisbord JS, Koumans EH, Toomey KE, Grayson C, Markowitz LE. · Epidemiology Program Office, and the Epidemiology and Surveillance Branch, Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. · South Med J. · Pubmed #11213942 No free full text.

Abstract: BACKGROUND: Sexually transmitted diseases (STD) during pregnancy are associated with adverse outcomes. We conducted a prenatal care provider survey to determine STD screening, diagnosis, and treatment practices. METHODS: Standard questionnaires were mailed to Georgia-licensed obstetrician/ gynecologists, family practitioners, and nurse-midwives (N = 3,082) in 1998. RESULTS: Of the 1,300 care providers who returned the survey, 565 (44%) provided prenatal care, 390 (57%) were male, and 396 (70%) were obstetrician/ gynecologists. Overall, 553 prenatal care providers (98%) reported screening all pregnant patients for syphilis, 551 (98%) for hepatitis B, 501 (89%) for trichomonas, 474 (84%) for human immunodeficiency virus (HIV), 401 (71%) for gonorrhea, 403 (71%) for chlamydia, 475 (84%) for group B streptococci, and 130 (23%) for bacterial vaginosis (BV) (high risk). Less than 10% used amplification tests for chlamydia or gonorrhea. Most providers used appropriate regimens to treat STD in pregnant women. A written office policy on testing for BV or HIV was associated with increased screening. CONCLUSIONS: Provider education is needed about diagnosis and treatment of STD during pregnancy.