1. Facilitator: Pawin Puapornpong
Journal club 6
Facilitator: Pawin Puapornpong

2. A 9-Valent HPV Vaccine against Infection and Intraepithelial Neoplasia in Women

3. Background
Medthod
Result
Discussion
Conclusion
Background
human papillomavirus (HPV) causes premalignant and malignant lesions of the cervix,vagina, vulva,anus,penis,oropharynx,as well as genital warts
HPV vaccine was efficacious against condyloma and cervical, vaginal, vulvar, and anal dysplasia
Current qHPV vaccine can protect cervical cancer 70%
five

4. Background 9vHPV is qvHPV plus five additional oncogenic types.
Medthod
Result
Discussion
Conclusion
Background
9vHPV is qvHPV plus five additional oncogenic types.
9vHPV is offered to increased prevention of cervical cancer from 70% to 90%

5. Background
Medthod
Result
Discussion
Conclusion
Hypothesis
9vHPV has more efficacy to prevent cervical cancer than qvHPV.
9vHPV and qvHPV would be similarly efficacy in preventing HPV-6,11,16 and 18.
Hypothesis have 2 point they are

6. Reserch question P(Patient):16-26yr women I(Intervention) :9vHPV
Background
Medthod
Result
Discussion
Conclusion
Reserch question
P(Patient):16-26yr women
I(Intervention) :9vHPV
C(control and comparison)  :qvHPV
O(Outcome):
1Incidence of disease
2 Immunogenicity
3 adverse event

7. Background
Medthod
Result
Discussion
Conclusion
Method
Type of randomized,international,double-blind control trial Study
Conducted in multiple medical center in international

8. Method, Population:Inclusion criteria
Background
Medthod
Result
Discussion
Conclusion
Method, Population:Inclusion criteria
16-26 yr women
received all three doses of vaccine within 1 year
seronegative on day 1 of the study
Negative results on PCR of HPV type being from day 1 through month 7

9. Method, Population:exclusion criteria
Background
Medthod
Result
Discussion
Conclusion
Method, Population:exclusion criteria
Had vaccination before study
Had cervical disease before study
History of abnormal PAP test
Loss to follow up
More than 4 sexual partner

10. day1,2 and 6 month Method 14215 7106 7109 9vHPV qvHPV
Background
Medthod
Result
Discussion
Conclusion
Method
14215
7106
7109
9vHPV
qvHPV
Vaccines were administered as a 0.5-ml intramuscular
injection in three doses, on day 1 and at
month 2 and month 6.
day1,2 and
6 month

11. Background
Medthod
Result
Discussion
Conclusion
Medthod:follow-up
Swabs of labial, vulvar, perineal, perianal, endocervical,and ectocervical tissue to PCR for HPV and Pap test
At day 1 and at months 7, 12, 18, 24, 30, 36, 42, 48,and 54.
Participants with
an abnormal result on a Pap test were referred for
colposcopy ang algorhythm mx

12. Background
Medthod
Result
Discussion
Conclusion
Medthod
recorded oral temperatures on each of the 5 days after vaccination
Recorded adverse events related to the injection site and systemic adverse events 15 days after vaccination.
Vaccination report card

13. Statistical analysis Analyse by percent risk reduction,95%CI
Background
Medthod
Result
Discussion
Conclusion
Statistical analysis
Analyse by percent risk reduction,95%CI

14. Background
Medthod
Result
Discussion
Conclusion
Result

15. Result:incidence of disease
Background
Medthod
Result
Discussion
Conclusion
Result:incidence of disease

16. Result:immunogenicity
Background
Medthod
Result
Discussion
Conclusion
Result:immunogenicity
no statistical significant

17. Background
Medthod
Result
Discussion
Conclusion
Result:adverse event

18. Background
Medthod
Result
Discussion
Conclusion
Result
Incidence of diseased:9vHPV can protect diseased related to five additional oncogenic type more than qvHPV
Immunogenicity: 9vHPV generated Ab to HPV-6,11, 16, and 18 was noninferior by qHPV vaccine
Adverse events:9vHPV more likely had injection site events than qvHPV
most common events
(incidence ≥2%) being pain, swelling, erythema,
and pruritus

19. Discussion:Strength Same characteristic population
Background
Medthod
Result
Discussion
Conclusion
Discussion:Strength
Same characteristic population
Follow-up out come by immunological and pathological test
Double blind study

20. Discussion:Limitation
Background
Medthod
Result
Discussion
Conclusion
Discussion:Limitation
No placebo control group
Follow-up was limited in duration 54 month
So cannot campare with unvaccinated poppulation

21. Background
Medthod
Result
Discussion
Conclusion
Conclusion
The 9vHPV vaccine prevented infection and disease related to HPV-31, 33, 45, 52,and 58 more than qvHPV
9vHPV generated an antibody response to HPV-6,11, 16, and 18 was noninferior by qHPV vaccine