HPV Opportunistic Vaccination: A Literature Review and a Single-Center Experience in Northern Italy through the COVID-19 Pandemic

Round 1

Reviewer 1 Report

The authors present a single-centre study of HPV opportunistic vaccination through the COVID -19 pandemic, but also extensively discussed other studies on the HPV opportunistic vaccination. The study itself is quite informative and provides a range of relevant information collected through questionnaires, as well as a link to clinical data on HPV screening and medical interventions.

Comments and recommendations:

1.     The authors noted that HPV vaccination programs declined during the COVID -19 pandemic, which is true for many vaccination programs worldwide. However, the data show that the number of vaccine doses was lower only in 2020, whereas the numbers in 2021 and 2022 were similar to or even slightly higher than in 2019. COVID -19 pandemic period needs to be clarified in the paper. If the 45.68% decline in opportunistic HPV vaccination refers only to 2020, this should be presented differently and not as a COVID -19 pandemic that lasted much longer.

2.     The paper is a mixture of research paper and literature review, which is sometimes confusing. While the first section follows the format of a research paper, the discussion only briefly addresses the major findings of the retrospective study conducted by the authors. Much of the section is devoted to detailed descriptions of other studies of opportunistic HPV vaccination and the COVID19 effect of vaccination programs–mostly without direct comparison with the original data obtained in the study.

I suggest that a detailed literature review be included in the Introduction section, where some of the studies described in the Discussion are mentioned already. The discussion could instead focus more on the actual results and their comparison with other recent studies in the field.

The English is generally good, but there are a few places where the meaning is not entirely clear.

Please restructure/modify the following sentences:

·       Page 2: This allowed to demonstrate how the response against the infection occurs in males as much as in females, managing to reduce the prevalence of HPV16 in 36% of males versus 21% of females.

·       Page 2: Sociodemographic factors such as educational level, socioeconomic status, personal beliefs, and immigration status may be associated with attitudes towards health primary prevention and vaccines, and thus towards HPV vaccine uptake [13,14].

·       Page 2: In Italy, the HPV vaccination campaign began in all regions by the end of 2008 with the goal of achieving 95% vaccination coverage within the following 5 years. Is this in females? Please clarify.

·       Please write out PLWH in full (page 8).

·       Page 9, line 362: Please replace “women with a significant option of increased viral clearance” to a more appropriate term.

Author Response

Authors wish to thank reviewer 1 for the precious comments and their reply follows:

1. clarification of the COVID-19 period in which the major decline in vaccination rates was observed has been made in the text
2. Introduction and Discussion section have been emended according to reviewer's comment
3. English language editing has been modified according to reviewer's suggestions

Reviewer 2 Report

While you have selected a critical issue, you can improve this Systematic review significantly by reporting other such reviews published and whether your findings corroborate with reported data. Here is a list that I am proposing for you to consider; not all may be relevant:

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English is OK but can be improved; 

 

Author Response

Authors wish to thank reviewer 2 for the precious comments.

Authors' reply: reviewer 2 provided a large amount of references to be considered for being included in manuscript; since a significant number of them focused on general aspects of population vaccination (rather than HPV vaccination), the authors selected a number of references, in their opinion relevant to the manuscript's scope, and included them in the text and reference list.

Reviewer 3 Report

1. This is a small descriptive paper. Further mining data to enhance the scientificity of the paper.

2. List statistical analysis in a separate chapter. Provide a detailed introduction to the statistical analysis methods used in this article.

3. Draw a table according to the requirements of the journal. It is recommended to use a three line table.

4. Statistical analysis is needed to determine whether there is a significant difference in the distribution of opportunistic vaccination among different populations. The statistical analysis results need to be labeled in the corresponding positions.

no

Author Response

The Authors wish to thank reviewer 3 for the precious comments and reply as follows.

1. Authors are aware that their article may be considered a "small descriptive" paper and they never thought or had the ambition to have submitted an Award Winning Paper. The issue of HPV opportunistic vaccination can be approached in different ways: virological, immunological, oncological, social, economical, an so on. In the authors' view, the option of choosing the socio-demographic aspects seemed to be interesting and informative for readers and clinicians. Obviously, the value of the manuscript can be improved and for that, reviewer 3 comments have been extensively taken into consideration.
2. Statistical analysis has been detailed in the text and performed where possible,  due to data availability and correctness of comparison.
3. A new table was considered redundant as data are clearly reported in the original tables 1 and 2
4. Statistical analysis is now clearly identifiable and labeled in the respective positions.

Round 2

Reviewer 1 Report

The authors have adequately addressed the issues raised in the first round of review, and the manuscript has been revised accordingly. I have no further comments on the manuscript and recommend that it be accepted for publication.

Author Response

Authors wish to thank reviewer 1 for approving the revised manuscript

Reviewer 2 Report

It is fine now

Author Response

Authors wish to thank reviewer 2 for approving the revised manuscript

Reviewer 3 Report

1.According to the reviewers' suggestions, the author made some modifications to the paper.

2. The author believes that the formats of Table 1 and table 2 need not be modified. The editor is requested to determine whether it meets the requirements of this journal.

3.It is necessary to statistically analyze whether there are significant differences between the data of different ages.

Minor editing of English language required.

Author Response

Further statistical analysis added according to reviewer's request

Further editing of English language performed