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  • br In Korea the Pap smear was


    In Korea, the Pap smear was first introduced in 1988 in a health examination for industrial workers [49]. In 1999, the National Cervical Cancer Screening Programme (NCCSP) was launched as a part of the National Health Care Screening Programme which supplied Medicaid 
    Fig. 3. Trends in genital warts prevalence in the Republic of Korea, by sex. “APC”: annual percent change Adjusted to residence-registration mid-year po-pulation in 2011..
    Data sources: Adapted from [45]
    participants with stomach, breast and cervical cancer screening free-of-charge [49]. The screening programme gradually expanded with in-cluding further participants and target cancer sites. Currently, the Korean government operates two population-based cervical screening programmes. The National Health Insurance Service Cancer Screening Programme (NHISCSP), which is offered to National Health Insurance Service (NHIS) beneficiaries in the upper 50% income stratum, and the National Cancer Screening Programme (NCSP), which is offered to NHIS beneficiaries in the lower 50% income stratum and Medical Aid Programme (MAP) recipients. Both programmes use the Pap test as the main screening tool, that is conducted by gynaecologists and provide complimentary biennial cervical cancer screening for all Korean women over the age of 30 [50]. Since 2016, the programme has been expanded to women over the age of 20 [51]. The percentage of women screened, among target population, has increased rapidly, from 41.1% in 2009, 53.0% in 2016 [1,50,52].
    4.1.2. National immunization programme (NIP) in Korea and current guidelines for HPV vaccine use
    In June 2016, the HPV vaccine (2-valent and 4-valent) was included in the NIP in Korea as a 2-dose schedule (0, 6 months) for 12 year old girls (based on birth cohort). Girls have at least two years to get the opportunity of being vaccinated within the NIP. The selection of the HPV vaccine was based on physician or patient/parent preference [54].
    4.2. Current status of HPV Z-VAD-FMK in Korea
    Confidence Interval; * “9HPV types” includes the ones in 9–valent HPV vaccine: HPVs 16/18/31/33/45/52/58/6/11. Eastern Asia: combined data for the following countries: China, Japan, Philippines, The Republic of Korea, Thailand and Taiwan. Type specific relative contribution estimations: Numerator = single infections + proportional attribution of multiple types; Denominator = HPV DNA positive cancer cases.. Data sources [9–14]
    Regarding previous vaccination rates in Korea, a nationwide survey on immunization rates conducted in 2013 (in cohorts born below 1993) reported an HPV vaccine coverage of 28.7% between the ages of 19 and 26 years, 15.9% between 27 and 39 years, and 4.6% between 40 and 59 years [56]. In addition, vaccination is recommended by professional societies, including the Korean Pediatric Society, the Korean Society of Pediatric Infectious Diseases, the Korean Society of Obstetrics and Gy-necology and the Korean Society of Gynecology Oncology.
    4.3. Barriers and facilitators of HPV vaccination introduction in Korea
    Globally, awareness and acceptance of vaccines in Korea (including social, cultural, and behavioural barriers and facilitators) is relatively high for childhood vaccines, although differences between NIP vs non-NIP vaccines are observed. A nationwide survey conducted in 2012 among 4374 participants aged 7–83 months showed 95.9–100.0% vaccination rates for NIP vaccines, and 30.7–85.4% for non-NIP vac-cines [57]. However, information in other age groups such as adoles-cents is still scarce.
    Regarding HPV vaccination in Korea, limited data is available prior to the inclusion of the HPV vaccine into the NIP in 2016. However, there are some vaccination data among hospital employees and re-latives during reduced-price vaccination programmes. HPV vaccine uptake increased from 2009 to 2010–2012 (370 and 515 subjects vac-cinated, respectively) and was probably attributed to an increased awareness of the benefits of the vaccine following media coverage and education of health professionals. In contrast, a decrease was observed in 2013 (17 women vaccinated during the programme) following the safety issues of the HPV vaccine in Japan (June 2013). The negative 
    reports from the media could have significantly impact the acceptance of HPV vaccination in Korea [58].
    In addition, a nationwide survey conducted in 2007, and updated in 2016, showed a significant increase in the awareness of HPV infection (from 13.3% in 2007 to 35.8% in 2016) and the preventive effect of the HPV vaccine (from 8.6% to 36.9%), and a decrease in the willingness to vaccinate against HPV (from 55.0% to 25.8%). Higher education level, awareness of HPV infection and vaccination, and perception of the seriousness of infection were positively associated with the willingness of respondents to vaccinate their daughters [59,60]. Another nation-wide survey in Korea revealed that mothers’ awareness of HPV vacci-nation is the most important method for preventing cervical cancer in their daughters. Further, in this study, mothers understood the im-portance of undergoing the Pap test regardless the administration of the HPV vaccine [61].