Cervical, Anal & Oral HPV Persistence/Adolescent Girls

从青春期到初露头角的成年期的特点是多个发育转变和 性传播感染(STI)的发病率最高。西班牙裔和非裔美国女性处于高危状态 HPV相关疾病和其他性传播疾病，包括宫颈癌和衣原体感染。 继2007年批准和发布四价(Gardasil)HPV疫苗后，我们发起了一项 参加西奈山的性活跃的市中心少数民族妇女(12-19岁)的前瞻性队列研究 青少年健康中心(MSAHC)，美国最大的综合性青少年初级保健机构 观察到接种疫苗后HPV感染率和相关的宫颈细胞学异常 在15岁或15岁以上接种≥的受试者中，他们花了12个月(而不是12个月)来完成3剂 疫苗接种时间表。此外，我们还发现了HPV疫苗增加宫颈感染风险的证据。 有心理-社会风险指标暴露史的受试者的类型和其他性传播疾病 家庭劣势、心理困扰和童年虐待/忽视史。去年，FDA 批准了一种新的9价HPV疫苗，减少了对青少年的剂量计划，基于 来自主要是高加索人和低风险妇女的短期桥接研究的证据 性伴侣。这项研究将评估新疫苗在高危人群中的实际效果。 人口。这一独特的研究队列还提供了探索新的创新领域的机会 与女性青春期健康相关的研究，特别是关于其他性传播感染和宫颈阴道的研究 微生物组。这一点特别重要，因为性病感染率在这一人群中很高，有三分之一的人获得了性病 衣原体。此外，我们观察到在妇女的宫颈样本中发现的某些类型的细菌 在我们的研究中，与衣原体和HPV感染风险增加相关。此外，我们 假设慢性压力和危险行为导致性传播感染和HPV突破的影响 感染可能在一定程度上受到宫颈阴道微生物群变化的影响。为了解决这些健康问题 为了解决少数族裔青年妇女的不平等问题，我们提议扩大我们现有的队列，并再招聘一名 1108名30岁以下有前瞻性随访的妇女：1)确定发病率是否降低 宫颈、肛门和口腔HPV感染与宫颈细胞学异常发生率的关系 对比四价HPV疫苗接种者；2)研究宫颈阴道微生物群与感染风险的关系 HPV和性传播感染；以及3)评估心理-社会因素之间的复杂联系，包括 儿童期虐待/忽视以及人乳头瘤病毒和性传播感染的风险。从这项研究中获得的数据将对 了解HPV疫苗接种对高危少数民族妇女的长期影响 疫苗试验，并将为未来的筛查实践提供生物学基础，以及估计 宫颈阴道菌群和心理社会因素对HPV和性传播感染风险的潜在影响。

The period from adolescence to emerging adulthood is characterized by multiple developmental transitions and peak incidence of sexually transmitted infections (STIs). Hispanic and African-American women are at high risk for HPV-associated and other sexually transmitted diseases, including cervical cancer and Chlamydia. Subsequent to the approval and release of the quadrivalent (Gardasil) HPV vaccine in 2007, we initiated a prospective cohort study of sexually-active, inner-city, minority women (aged 12-19) attending the Mount Sinai Adolescent Health Center (MSAHC), the largest comprehensive adolescent primary care facility in the U.S. We observed higher rates of HPV infection and associated cervical cytological abnormalities post-vaccination among subjects immunized at age 15 or older who took ≥12 months (vs. <12 months) to complete the 3-dose vaccine schedule. Furthermore, we found evidence for increased risk of cervical infection with HPV vaccine types and other STIs among subjects with a history of exposure to psycho-social risk indicators reflecting family disadvantage, psychological distress, and history of childhood abuse/neglect. Last year, the FDA approved a new 9-valent HPV vaccine with a reduced dosing schedule for younger adolescents based on evidence from short term bridging studies of primarily Caucasian and low-risk women with limited numbers of sexual partners. This study will assess the real-world effectiveness of the new vaccine in a high-risk minority population. This unique study cohort also provides opportunities to explore new and innovative areas of research relevant to adolescent health in women, especially with respect to other STIs, and the cervicovaginal microbiome. This is of particular relevance since STI rates are high in this population, with a third acquiring Chlamydia. In addition, we observed that certain types of bacteria found in the cervical specimens from women in our study were associated with increased risks of Chlamydia and HPV infection. Furthermore we hypothesize that the impact of chronic stress and risky behaviors leading to STIs and breakthrough HPV infections may be influenced in part by changes in the cervicovaginal microbiome. To address these health disparities in minority young women, we are proposing to expand our existing cohort and recruit an additional 1108 women with prospective follow-up to age 30 to: 1) determine whether there is a reduction in the incidence of cervical, anal and oral HPV infection and incidence of cervical cytological abnormalities among 9-valent versus quadrivalent HPV vaccinees; 2) study the association between cervicovaginal microbiome and risk of HPV and STIs; and 3) assess the complex associations between psycho-social factors including history of childhood abuse/neglect and risk of HPV and STIs. Data obtained from this study will be essential to understanding the long-term impacts of HPV vaccination in high-risk, minority women not studied in the vaccine trials, and will provide the biological underpinnings for future screening practices, as well as estimating the potential impact of the cervicovaginal microbiome and psycho-social factors on risk of HPV and STIs.