Willingness to get HPV vaccination among female university students in Kuwait and its relation to vaccine conspiracy beliefs

Mariam Alsanafi 1 2, Nesreen A Salim 3 4, Malik Sallam 5 6

Affiliations

18 March 2023

-

doi: 10.1080/21645515.2023.2194772

Abstract

A substantial burden of high-risk human papillomavirus (HPV) infections and HPV-related cancers can be mitigated by vaccination. The current study aimed to investigate the willingness of female students at the University of Kuwait to get HPV vaccination and its possible association with general vaccine conspiracy beliefs (VCBs). This cross-sectional survey study was conducted during September-November 2022 using a validated VCB scale as the survey instrument. The final sample comprised 611 respondents with a median age of 22 y and a majority of Arab ethnicity (n = 600, 98.2%). Only 360 respondents (56.9%) heard of HPV before participation and these students showed an above-average level of HPV knowledge (mean knowledge score of 12.7 ± 2.6 out of 16 as the maximum score), of whom only 33 self-reported HPV vaccine uptake (9.2%). The willingness to accept free-of-charge HPV vaccination was seen among 69.8% of the participants, with 20.1% who were hesitant and 10.1% who were resistant. The acceptance of HPV vaccination if payment is required was 23.1%. Reasons for HPV vaccine hesitancy/resistance included complacency to the HPV disease risks, lack of confidence in HPV vaccination, and inconvenience. The embrace of VCBs was associated with significantly higher odds of HPV vaccine hesitancy/resistance. The current study showed the detrimental impact of endorsing vaccine conspiracy beliefs manifested in lower intention to get HPV vaccination among female university students in Kuwait. This should be considered in vaccine promotion efforts aiming to reduce the burden of HPV cancers.

Keywords: Vaccine attitude; awareness; sexually transmitted infection; vaccine acceptance.

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Similar articles

Knowledge and willingness of parents towards child girl HPV vaccination in Debre Tabor Town, Ethiopia: a community-based cross-sectional study.

Mihretie GN, Liyeh TM, Ayele AD, Belay HG, Yimer TS, Miskr AD.Reprod Health. 2022 Jun 10;19(1):136. doi: 10.1186/s12978-022-01444-4.PMID: 35689288 Free PMC article.

Factors influencing Chinese female college students' willingness to receive human papillomavirus vaccine: A cross-sectional study based on information-motivation-behavioral skills model.

Wang H, Wang X, Chen P, Xu H, Liu Y, Kang R, Zheng L, Sun X, Sun X, Qiao Y, Zhang S.Hum Vaccin Immunother. 2022 Dec 30;18(7):2140550. doi: 10.1080/21645515.2022.2140550. Epub 2022 Dec 5.PMID: 36469625 Free PMC article.

Human papillomavirus (HPV) infection and vaccines: knowledge, attitude and perception among female students at the University of Lagos, Lagos, Nigeria.

Makwe CC, Anorlu RI, Odeyemi KA.J Epidemiol Glob Health. 2012 Dec;2(4):199-206. doi: 10.1016/j.jegh.2012.11.001. Epub 2012 Dec 8.PMID: 23856501 Free PMC article.

Attitude towards HPV Vaccination and the Intention to Get Vaccinated among Female University Students in Health Schools in Jordan.

Sallam M, Al-Mahzoum K, Eid H, Assaf AM, Abdaljaleel M, Al-Abbadi M, Mahafzah A.Vaccines (Basel). 2021 Dec 3;9(12):1432. doi: 10.3390/vaccines9121432.PMID: 34960177 Free PMC article.

Human Papillomavirus Vaccine Uptake After a Tailored, Online Educational Intervention for Female University Students: A Randomized Controlled Trial.

Bennett AT, Patel DA, Carlos RC, Zochowski MK, Pennewell SM, Chi AM, Dalton VK.J Womens Health (Larchmt). 2015 Nov;24(11):950-7. doi: 10.1089/jwh.2015.5251. Epub 2015 Oct 21.PMID: 26488269 Free PMC article. Clinical Trial.

References

  1.  
    1. Kombe Kombe AJ, Li B, Zahid A, Mengist HM, Bounda GA, Zhou Y, Jin T.. Epidemiology and burden of human papillomavirus and related diseases, molecular pathogenesis, and vaccine evaluation. Front Public Health. 2020;8:552028. doi:10.3389/fpubh.2020.552028. - DOI - PMC - PubMed
  2.  
    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: gLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–10. doi:10.3322/caac.21660. - DOI - PubMed
  3.  
    1. Zhao M, Wu Q, Hao Y, Hu J, Gao Y, Zhou S, Han L. Global, regional, and national burden of cervical cancer for 195 countries and territories, 2007–2017: findings from the global burden of disease study 2017. BMC Womens Health. 2021;21:419. doi:10.1186/s12905-021-01571-3. - DOI - PMC - PubMed
  4.  
    1. Boda D, Docea AO, Calina D, Ilie MA, Caruntu C, Zurac S, Neagu M, Constantin C, Branisteanu D, Voiculescu V, et al. Human papilloma virus: apprehending the link with carcinogenesis and unveiling new research avenues (Review). Int J Oncol. 2018;52:637–55. doi:10.3892/ijo.2018.4256. - DOI - PMC - PubMed
  5.  
    1. Gravitt PE, Winer RL. Natural history of HPV infection across the lifespan: role of Viral Latency. Viruses. 2017;9:267. doi:10.3390/v9100267. - DOI - PMC - PubMed
  6.  
    1. Christensen ND. HPV disease transmission protection and control. Microb Cell. 2016;3:476–90. doi:10.15698/mic2016.09.530. - DOI - PMC - PubMed
  7.  
    1. Egawa N, Egawa K, Griffin H, Doorbar J. Human papillomaviruses; epithelial tropisms, and the development of Neoplasia. Viruses. 2015;7:3863–90. doi:10.3390/v7072802. - DOI - PMC - PubMed
  8.  
    1. Petca A, Borislavschi A, Zvanca ME, Petca RC, Sandru F, Dumitrascu MC. Non-sexual HPV transmission and role of vaccination for a better future (review). Exp Ther Med. 2020;20:186. doi:10.3892/etm.2020.9316. - DOI - PMC - PubMed
  9.  
    1. Panatto D, Amicizia D, Trucchi C, Casabona F, Lai PL, Bonanni P, Boccalini S, Bechini A, Tiscione E, Zotti CM, et al. Sexual behaviour and risk factors for the acquisition of human papillomavirus infections in young people in Italy: suggestions for future vaccination policies. BMC Public Health. 2012;12:623. doi:10.1186/1471-2458-12-623. - DOI - PMC - PubMed
  10.  
    1. Lehoux M, D’abramo CM, Archambault J. Molecular mechanisms of human papillomavirus-induced carcinogenesis. Public Health Genomics. 2009;12:268–80. doi:10.1159/000214918. - DOI - PMC - PubMed
  11.  
    1. Chan CK, Aimagambetova G, Ukybassova T, Kongrtay K, Azizan A. Human papillomavirus infection and cervical cancer: epidemiology, screening, and vaccination-review of current perspectives. J Oncol. 2019;2019:3257939. doi:10.1155/2019/3257939. - DOI - PMC - PubMed
  12.  
    1. World Health Organization . Global strategy to accelerate the elimination of cervical cancer as a public health problem. [accessed 2023 Feb 9]. https://www.who.int/publications/i/item/9789240014107.
  13.  
    1. Canfell K, Kim JJ, Brisson M, Keane A, Simms KT, Caruana M, Burger EA, Martin D, Nguyen DTN, Bénard É, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020;395:591–603. doi:10.1016/s0140-6736(20)30157-4. - DOI - PMC - PubMed
  14.  
    1. Wang R, Pan W, Jin L, Huang W, Li Y, Wu D, Gao C, Ma D, Liao S. Human papillomavirus vaccine against cervical cancer: opportunity and challenge. Cancer Lett. 2020;471:88–102. doi:10.1016/j.canlet.2019.11.039. - DOI - PubMed
  15.  
    1. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human papillomavirus vaccination for adults: updated recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2019;68:698–702. doi:10.15585/mmwr.mm6832a3. - DOI - PMC - PubMed
  16.  
    1. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination - updated recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2016;65:1405–8. doi:10.15585/mmwr.mm6549a5. - DOI - PubMed
  17.  
    1. Soliman M, Oredein O, Dass CR. Update on safety and efficacy of HPV vaccines: focus on gardasil. Int J Mol Cell Med. 2021;10:101–13. doi:10.22088/ijmcm.Bums.10.2.101. - DOI - PMC - PubMed
  18.  
    1. Arbyn M, Xu L. Efficacy and safety of prophylactic HPV vaccines. A Cochrane review of randomized trials. Expert Rev Vaccines. 2018;17:1085–91. doi:10.1080/14760584.2018.1548282. - DOI - PubMed
  19.  
    1. Porras C, Tsang SH, Herrero R, Guillén D, Darragh TM, Stoler MH, Hildesheim A, Wagner S, Boland J, Lowy DR, et al. Efficacy of the bivalent HPV vaccine against HPV 16/18-associated precancer: long-term follow-up results from the Costa Rica vaccine trial. Lancet Oncol. 2020;21:1643–52. doi:10.1016/s1470-2045(20)30524-6. - DOI - PMC - PubMed
  20.  
    1. Al-Awadhi R, Chehadeh W, Kapila K. Prevalence of human papillomavirus among women with normal cervical cytology in Kuwait. J Med Virol. 2011;83:453–60. doi:10.1002/jmv.21981. - DOI - PubMed
  21.  
    1. Al-Awadhi R, Chehadeh W, Jaragh M, Al-Shaheen A, Sharma P, Kapila K. Distribution of human papillomavirus among women with abnormal cervical cytology in Kuwait. Diagn Cytopathol. 2013;41:107–14. doi:10.1002/dc.21778. - DOI - PubMed
  22.  
    1. Sallam M, Al-Mahzoum K, Eid H, Assaf AM, Abdaljaleel M, Al-Abbadi M, Mahafzah A. Attitude towards HPV vaccination and the intention to get vaccinated among female university students in health schools in Jordan. Vaccines (Basel). 2021;9:1432. doi:10.3390/vaccines9121432. - DOI - PMC - PubMed
  23.  
    1. Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine. 2014;32:2150–9. doi:10.1016/j.vaccine.2014.01.081. - DOI - PubMed
  24.  
    1. Bencherit D, Kidar R, Otmani S, Sallam M, Samara K, Barqawi HJ, Lounis M. Knowledge and awareness of Algerian students about cervical cancer, HPV and HPV vaccines: a cross-sectional study. Vaccines (Basel). 2022;10:1420. doi:10.3390/vaccines10091420. - DOI - PMC - PubMed
  25.  
    1. Fernandes Q, Allouch S, Gupta I, Elmakaty I, Elzawawi KE, Amarah A, Al-Thawadi H, Al-Farsi H, Vranic S, Al Moustafa A-E. Human papillomaviruses-related cancers: an update on the presence and prevention strategies in the Middle East and North African regions. Pathogens. 2022;11:1380. doi:10.3390/pathogens11111380. - DOI - PMC - PubMed
  26.  
    1. Sallam M, Al-Fraihat E, Dababseh D, Yaseen A, Taim D, Zabadi S, Hamdan AA, Hassona Y, Mahafzah A, Şahin GÖ. Dental students’ awareness and attitudes toward HPV-related oral cancer: a cross sectional study at the university of Jordan. BMC Oral Health. 2019;19:171. doi:10.1186/s12903-019-0864-8. - DOI - PMC - PubMed
  27.  
    1. Sallam M, Dababseh D, Yaseen A, Al-Haidar A, Ettarras H, Jaafreh D, Hasan H, Al‐salahat K, Al‐fraihat E, Hassona Y, et al. Lack of knowledge regarding HPV and its relation to oropharyngeal cancer among medical students. Cancer Rep (Hoboken). 2022;5:e1517. doi:10.1002/cnr2.1517. - DOI - PMC - PubMed
  28.  
    1. Alsous MM, Ali AA, Al-Azzam SI, Abdel Jalil MH, Al-Obaidi HJ, Al-Abbadi EI, Hussain ZK, Jirjees FJ. Knowledge and awareness about human papillomavirus infection and its vaccination among women in Arab communities. Sci Rep. 2021;11:786. doi:10.1038/s41598-020-80834-9. - DOI - PMC - PubMed
  29.  
    1. Rezqalla J, Alshatti M, Ibraheem A, Omar D, Houda AF, AlHaqqan S, AlGhurair S, Akhtar S. Human papillomavirus (HPV): unawareness of the causal role of HPV infection in cervical cancer, HPV vaccine availability, and HPV vaccine uptake among female school teachers in a Middle Eastern country. J Infect Public Health. 2021;14:661–7. doi:10.1016/j.jiph.2021.01.015. - DOI - PubMed
  30.  
    1. Albanghali MA, Othman BA. A cross-sectional study on the knowledge of sexually transmitted diseases among young adults living in Al Bahah, Saudi Arabia. Int J Environ Res Public Health. 2020;17:1872. doi:10.3390/ijerph17061872. - DOI - PMC - PubMed
  31.  
    1. Horanieh N, Macdowall W, Wellings K. How should school-based sex education be provided for adolescents in Saudi Arabia? Views of stakeholders. Sex Educ. 2021;21:645–59. doi:10.1080/14681811.2020.1843424. - DOI
  32.  
    1. Bruni L, Albero G, Serrano B, Mena M, Collado J, Gómez D, Muñoz, J, Bosch, F, de Sanjosé, S. Human Papillomavirus and Related Diseases in Kuwait. Summary Report. [accessed 2023 Feb 9]. https://hpvcentre.net/statistics/reports/KWT.pdf.
  33.  
    1. Milondzo T, Meyer JC, Dochez C, Burnett RJ. Human papillomavirus vaccine hesitancy highly evident among caregivers of girls attending South African private schools. Vaccines (Basel). 2022;10:503. doi:10.3390/vaccines10040503. - DOI - PMC - PubMed
  34.  
    1. Sallam M, Dababseh D, Eid H, Al-Mahzoum K, Al-Haidar A, Taim D, Yaseen A, Ababneh NA, Bakri FG, Mahafzah A. High rates of COVID-19 vaccine hesitancy and its association with conspiracy beliefs: a study in Jordan and Kuwait among other Arab countries. Vaccines (Basel). 2021;9:42. doi:10.3390/vaccines9010042. - DOI - PMC - PubMed
  35.  
    1. Al-Sanafi M, Sallam M. Psychological determinants of COVID-19 vaccine acceptance among healthcare workers in Kuwait: a cross-sectional study using the 5C and vaccine conspiracy beliefs scales. Vaccines (Basel). 2021;9:701. doi:10.3390/vaccines9070701. - DOI - PMC - PubMed
  36.  
    1. Alsanafi M, Al-Mahzoum K, Sallam M. Monkeypox knowledge and confidence in diagnosis and management with evaluation of emerging virus infection conspiracies among health professionals in Kuwait. Pathogens. 2022;11:994. doi:10.3390/pathogens11090994. - DOI - PMC - PubMed
  37.  
    1. Milondzo T, Meyer JC, Dochez C, Burnett RJ. Misinformation drives low human papillomavirus vaccination coverage in South African girls attending private schools. Front Public Health. 2021;9:598625. doi:10.3389/fpubh.2021.598625. - DOI - PMC - PubMed
  38.  
    1. Kuwait University . About Kuwait University. [accessed 2023 Feb 9]. http://kuweb.ku.edu.kw/ku/ar/AboutUniversity/AboutKU/AboutUSKU/index.htm.
  39.  
    1. Shapiro GK, Holding A, Perez S, Amsel R, Rosberger Z. Validation of the vaccine conspiracy beliefs scale. Papillomavirus Res. 2016;2:167–72. doi:10.1016/j.pvr.2016.09.001. - DOI - PMC - PubMed
  40.  
    1. Dany M, Chidiac A, Nassar AH. Human papillomavirus vaccination: assessing knowledge, attitudes, and intentions of college female students in Lebanon, a developing country. Vaccine. 2015;33:1001–7. doi:10.1016/j.vaccine.2015.01.009. - DOI - PubMed
  41.  
    1. Abou El-Ola MJ, Rajab MA, Abdallah DI, Fawaz IA, Awad LS, Tamim HM, Ibrahim A, Mugharbil A, Moghnieh R. Low rate of human papillomavirus vaccination among schoolgirls in Lebanon: barriers to vaccination with a focus on mothers’ knowledge about available vaccines. Ther Clin Risk Manag. 2018;14:617–26. doi:10.2147/tcrm.S152737. - DOI - PMC - PubMed
  42.  
    1. Al Shdefat S, Al Awar S, Osman N, Khair H, Sallam G, Maki S. Identification level of awareness and knowledge of Emirati men about HPV. J Healthc Eng. 2022;2022:5340064. doi:10.1155/2022/5340064. - DOI - PMC - PubMed
  43.  
    1. Haddad SF, Kerbage A, Eid R, Kourie HR. Awareness about the human papillomavirus (HPV) and HPV vaccine among medical students in Lebanon. J Med Virol. 2022;94:2796–801. doi:10.1002/jmv.27509. - DOI - PubMed
  44.  
    1. Abi Jaoude J, Khair D, Dagher H, Saad H, Cherfan P, Kaafarani MA, Jamaluddine Z, Ghattas H. Factors associated with human papilloma virus (HPV) vaccine recommendation by physicians in Lebanon, a cross-sectional study. Vaccine. 2018;36:7562–7. doi:10.1016/j.vaccine.2018.10.065. - DOI - PubMed
  45.  
    1. Abi Jaoude J, Saad H, Farha L, Dagher H, Khair D, Kaafarani MA, Jamaluddine Z, Cherfan P. Barriers, attitudes and clinical approach of Lebanese physicians towards HPV vaccination; a cross- sectional study. Asian Pac J Cancer Prev. 2019;20:3181–7. doi:10.31557/apjcp.2019.20.10.3181. - DOI - PMC - PubMed
  46.  
    1. Hamdi S. The impact of teachings on sexuality in Islam on HPV vaccine acceptability in the Middle East and North Africa region. J Epidemiol Glob Health. 2018;7(Suppl S1):S17–s22. doi:10.1016/j.jegh.2018.02.003. - DOI - PMC - PubMed
  47.  
    1. Farsi NJ, Baharoon AH, Jiffri AE, Marzouki HZ, Merdad MA, Merdad LA. Human papillomavirus knowledge and vaccine acceptability among male medical students in Saudi Arabia. Hum Vaccin Immunother. 2021;17:1968–74. doi:10.1080/21645515.2020.1856597. - DOI - PMC - PubMed
  48.  
    1. Obeid DA, Almatrrouk SA, Alfageeh MB, Al-Ahdal MNA, Alhamlan FS. Human papillomavirus epidemiology in populations with normal or abnormal cervical cytology or cervical cancer in the Middle East and North Africa: a systematic review and meta-analysis. J Infect Public Health. 2020;13:1304–13. doi:10.1016/j.jiph.2020.06.012. - DOI - PubMed
  49.  
    1. Dochez C, Al Awaidy S, Mohsni E, Fahmy K, Bouskraoui M. Strengthening national teams of experts to support HPV vaccine introduction in Eastern Mediterranean countries: lessons learnt and recommendations from an international workshop. Vaccine. 2020;38:1114–19. doi:10.1016/j.vaccine.2019.11.027. - DOI - PubMed
  50.  
    1. Abdullahi LH, Hussey GD, Wiysonge CS, Kagina BM. Lessons learnt during the national introduction of human papillomavirus (HPV) vaccination programmes in 6 African countries: stakeholders’ perspectives. S Afr Med J. 2020;110:525–31. doi:10.7196/SAMJ.2020.v110i6.14332. - DOI - PubMed
  51.  
    1. Gamaoun R. Knowledge, awareness and acceptability of anti-HPV vaccine in the Arab states of the Middle East and North Africa region: a systematic review. East Mediterr Health J. 2018;24:538–48. doi:10.26719/2018.24.6.538. - DOI - PubMed
  52.  
    1. Huang Y, Chen C, Wang L, Wu H, Chen T, Zhang L. HPV vaccine hesitancy and influencing factors among university students in China: a cross-sectional survey based on the 3cs model. Int J Environ Res Public Health. 2022;19:14025. doi:10.3390/ijerph192114025. - DOI - PMC - PubMed
  53.  
    1. Van Boetzelaer E, Daae A, Winje BA, Vestrheim DF, Steens A, Stefanoff P. Sociodemographic determinants of catch-up HPV vaccination completion between 2016-2019 in Norway. Hum Vaccin Immunother. 2022;18:1976035. doi:10.1080/21645515.2021.1976035. - DOI - PMC - PubMed
  54.  
    1. Sidiropoulou M, Gerogianni G, Kourti FE, Pappa D, Zartaloudi A, Koutelekos I, Dousis E, Margari N, Mangoulia P, Ferentinou E, et al. Perceptions, knowledge and attitudes among young adults about prevention of HPV infection and immunization. Healthcare (Basel). 2022;10:1721. doi:10.3390/healthcare10091721. - DOI - PMC - PubMed
  55.  
    1. Ortashi O, Raheel H, Shalal M. Acceptability of human papilloma virus vaccination among women in the United Arab Emirates. Asian Pac J Cancer Prev. 2014;15:2007–11. doi:10.7314/apjcp.2014.15.5.2007. - DOI - PubMed
  56.  
    1. Abu-Raddad LJ, Ghanem KG, Feizzadeh A, Setayesh H, Calleja JM, Riedner G. HIV and other sexually transmitted infection research in the Middle East and North Africa: promising progress? Sex Transm Infect. 2013;89(Suppl S3):iii1–4. doi:10.1136/sextrans-2013-051373. - DOI - PMC - PubMed
  57.  
    1. Mallik MK, Alramadhan B, Dashti H, Al-Shaheen A, Al Juwaiser A, Das DK, George SS, Kapila K. Human papillomaviruses other than 16, 18 and 45 are the major high risk HPV genotypes amongst women with abnormal cervical smear cytology residing in Kuwait: implications for future vaccination strategies. Diagn Cytopathol. 2018;46:1036–9. doi:10.1002/dc.24035. - DOI - PubMed
  58.  
    1. Kapila K, Balakrishnan M, Ali RH, Al-Juwaiser A, George SS, Mallik MK. Interpreting a diagnosis of atypical squamous cells of undetermined significance in cervical cytology and its association with human papillomavirus: a retrospective analysis of 180 cases in Kuwait. Sultan Qaboos Univ Med J. 2020;20:e318–23. doi:10.18295/squmj.2020.20.04.007. - DOI - PMC - PubMed
  59.  
    1. World Health Organization . Human papillomavirus vaccines: wHO position paper, October 2014-recommendations. Vaccine. 2015;33:4383–4. doi:10.1016/j.vaccine.2014.12.002. - DOI - PubMed
  60.  
    1. Barnard M, Cole AC, Ward L, Gravlee E, Cole ML, Compretta C. Interventions to increase uptake of the human papillomavirus vaccine in unvaccinated college students: a systematic literature review. Prev Med Rep. 2019;14:100884. doi:10.1016/j.pmedr.2019.100884. - DOI - PMC - PubMed
  61.  
    1. Sallam M, Ghazy RM, Al-Salahat K, Al-Mahzoum K, AlHadidi NM, Eid H, Kareem N, Al-Ajlouni E, Batarseh R, Ababneh NA, et al. The role of psychological factors and vaccine conspiracy beliefs in influenza vaccine hesitancy and uptake among Jordanian healthcare workers during the COVID-19 pandemic. Vaccines (Basel). 2022;10:1355. doi:10.3390/vaccines10081355. - DOI - PMC - PubMed
  62.  
    1. Peretti-Watel P, Larson HJ, Ward JK, Schulz WS, Verger P. Vaccine hesitancy: clarifying a theoretical framework for an ambiguous notion. PLoS Curr. 2015;7. doi:10.1371/currents.outbreaks.6844c80ff9f5b273f34c91f71b7fc289. - DOI - PMC - PubMed

Page Navigation