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Vié le Sage F, Cohen R. [Preventing cancer: The role of Papillomavirus vaccination in the general population]. Bull Cancer 2020; 107:10-20. [PMID: 31982092 DOI: 10.1016/j.bulcan.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
Abstract
Papillomavirus (HPV), the first sexually transmitted disease in the world, is the main infectious agent responsible for cancer (6300 per year, in France). The cycle of HPV infection - >precancerous lesions - >cancer is well documented with regard to the cervix (cf. Nobel Prize in 2008). While this area is the most frequent (3000), it is far from being the only one. Other cancers include the anus, oropharyngeal sphere, glans and vulva. The sum of these other induced HPV cancers is greater than the total number of cervical cancers and also concerns boys. Screening is essential but insufficient and only concerns the cervix. Only vaccination can provide primary and general prevention. Since 2007, there have been many studies demonstrating its excellent efficacy and tolerance. However, France lags behind other countries with a vaccination coverage (<30 %) that does not allow for an epidemiological impact.
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Affiliation(s)
- François Vié le Sage
- (AFPA) Association Française de Pédiatrie Ambulatoire, cabinet de pédiatrie, 67, rue Alexandre-Dumas, 73100 Aix-les-Bains, France.
| | - Robert Cohen
- Infovac, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France
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Li Y, Zhu P, Wu M, Zhang Y, Li L. Immunogenicity and safety of human papillomavirus vaccine coadministered with other vaccines in individuals aged 9-25 years: A systematic review and meta-analysis. Vaccine 2020; 38:119-134. [PMID: 31831220 DOI: 10.1016/j.vaccine.2019.10.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/09/2019] [Accepted: 10/28/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Adolescents and young adults are at a high risk of developing human papillomavirus (HPV) infections, which can be prevented with the use of vaccines. Moreover, a combined immunization strategy for administration of HPV vaccines with other routine vaccines may lead to better compliance. We aim to comprehensively evaluate immunogenicity and safety in the case of concomitantly administered HPV vaccine in individuals aged 9-25 years. METHODS Relevant studies, published up to December 27, 2018, were identified through searches of Medline/PubMed, EMBASE, Web of Knowledge. The pooled relative risk (RR) of immunogenicity and safety information pertaining to the concomitant administration of HPV vaccines with other routine vaccines in healthy participants aged 9-25 years were evaluated. RESULTS A total of 13 papers (11,657 participants) were included in this meta-analysis. The analyses showed that, between the concomitant and nonconcomitant administration groups, the seroconversion rate for the specific antibodies against all HPV types (type 16-, 18-, 6-, 11-, 31-, 33-, 45-, 52-, and 58) were the same (the pooled RR = 1.00, 95% confidence interval (CI) of 1.00-1.00); for the bivalent HPV (2vHPV) vaccine, the risks of local adverse events showed no significant difference (the pooled RR = 1.00, 95%CI: 0.97-1.04), and the risks of systemic adverse events were almost similar (the pooled RR = 1.10, 95% CI: 1.03-1.18); for the non-bivalent HPV (4vHPV and 9vHPV) vaccines, the risks of local adverse events were slightly higher in the concomitant administration groups (the pooled RR = 1.31, 95%CI: 1.17-1.47), and the risks of systemic adverse events were higher in the concomitant administration groups (the pooled RR = 2.09, 95% CI: 1.69-2.59). CONCLUSIONS We believe that the concomitant administration of other vaccines along with HPV vaccine is acceptable and there is no interference with the immune response to HPV vaccine. Concomitant vaccine administration has the potential to minimize the number of vaccination visits, leading to increased compliance, hence more effective disease prevention.
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Affiliation(s)
- Yaowei Li
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, Guangxi, China; Department of Gynecology and Obstetrics, Shangyu People's Hospital, Shangyu, Zhejiang, China
| | - Pengfei Zhu
- Department of Gynecology and Obstetrics, Shangyu People's Hospital, Shangyu, Zhejiang, China
| | - Meifen Wu
- Department of Gynecology and Obstetrics, Shangyu People's Hospital, Shangyu, Zhejiang, China
| | - Yiqing Zhang
- Department of Gynecology and Obstetrics, Shangyu People's Hospital, Shangyu, Zhejiang, China
| | - Li Li
- Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning, Guangxi, China.
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Duan R, Qiao Y, Clifford G, Zhao F. Cancer burden attributable to human papillomavirus infection by sex, cancer site, age, and geographical area in China. Cancer Med 2020; 9:374-384. [PMID: 31714036 PMCID: PMC6943148 DOI: 10.1002/cam4.2697] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/14/2019] [Accepted: 10/27/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) attributable cancer burden is currently unknown in China, which is essential to evaluate the potential benefit of existing HPV vaccines and to inform cancer control policy. METHODS We extracted data of cancer incidence and mortality in 2014 from Chinese Cancer Registry Annual Report, and data of national population from National Bureau of Statistics. HPV-attributable cancer burden was estimated by incorporating cancer rates and population forecasts by sex, cancer site, age and geographical area, and then combined to corresponding population attributable fractions. RESULTS We estimated that there were 110 894 HPV-attributable new cancer cases in China in 2014, including 99 253 cervical cancers, 4449 noncervical cancers in females and 7192 cancers in males. The age-standardized incidence of HPV-attributable cancers in China was 5.69 per 100 000 persons, being slightly higher in rural than urban areas. Specifically, 51.1% of HPV-attributable cervical cancers were diagnosed in women aged 40-54 years, while 75.8% of noncervical cancers were diagnosed at 45-79 years of age. Among males, 53.4% of cancers were diagnosed at 55-74 years of age. Thirty five thousand six hundred and eighty three HPV-attributable cancer deaths were estimated, including 29 683 due to cervical cancer, and 2307 and 3693 due to noncervical cancer in females and males, respectively. CONCLUSIONS The cancer burden attributable to HPV in China is substantial. HPV vaccination and cervical screening should be prioritized.
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Affiliation(s)
- Rufei Duan
- National Cancer CenterNational Clinical Research Center for CancerCancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Youlin Qiao
- National Cancer CenterNational Clinical Research Center for CancerCancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Gary Clifford
- International Agency for Research on CancerLyonFrance
| | - Fanghui Zhao
- National Cancer CenterNational Clinical Research Center for CancerCancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Subasinghe AK, Wark JD, Phillips S, Cornall A, Brotherton JML, Garland SM. Quadrivalent human papillomavirus vaccination successfully reduces the prevalence of vaccine-targeted genotypes in a young, vaccine-eligible-age sample of Australian females. Sex Health 2020; 17:510-516. [PMID: 33341122 DOI: 10.1071/sh20033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022]
Abstract
Background The prevalence of genital tract vaccine-type human papillomavirus (HPV) is on the decline due to high vaccine uptake through the national HPV immunisation program in Australia. The aim of this study was to investigate HPV vaccine coverage and factors associated with HPV in a vaccine-eligible sample of young Australian females. METHODS Females aged 16-25 years were recruited into the Young Female Health Initiative study, a young women's health study, via Facebook advertising from 2012 to 2017. Sexually active participants were asked to provide a self-collected vaginal swab for the detection of HPV DNA; positive samples were genotyped. Self-reported HPV vaccination status was confirmed by the National HPV Vaccination Program Register. Outcomes of the study were HPV acquisition and genotype, HPV vaccination status and factors associated with HPV. RESULTS Overall, 22.8% of samples (95% confidence interval (CI) 17.8-27.8%; n = 62/272) were positive for any HPV DNA, of which 19.1% (95% CI 14.4-23.8%; n = 52/272) were oncogenic types. HPV 16 was detected in three samples (1.1%; 95% CI -0.1%, 2.3%; two not HPV vaccinated and one vaccinated after sexual debut). Early sexual debut (<16 years) and multiple sexual partners were independently associated with an increased risk of any HPV. CONCLUSIONS In a community sample of vaccine-eligible-age females with a high vaccine uptake, the prevalence of vaccine-related HPV genotypes is extremely low. Early sexual debut and multiple sexual partners are positively associated with HPV, underscoring the importance of vaccination at the routinely recommended age of 12-13 years for best vaccine impact.
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Affiliation(s)
- Asvini K Subasinghe
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Present address: Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
| | - John D Wark
- The University of Melbourne Department of Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia; and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia
| | - Samuel Phillips
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia
| | - Alyssa Cornall
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne, Vic. 3002, Australia; and Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3053, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
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Abstract
Introduction: The randomized control trials (RCTs) that resulted in licensure of HPV VLP vaccines used a traditional prime, prime-boost schedule for a subunit protein vaccine. These vaccines delivered predominantly to 9-14-year-old females with this schedule have been shown to be highly effective against vaccine HPV-type disease (CIN and genital warts) and infection. A two-dose prime-boost schedule is immunologically non-inferior to 3 doses in 9-14-year-olds and is currently widely adopted. However, even with a reduced dosage schedule, these vaccines are expensive to buy and expensive and logistically complex to deliver especially in low resource countries that bear the major burden of cervical cancer the most prevalent of HPV caused cancers.Areas covered: Observational studies and post hoc analysis of RCTs show that 1 dose, although immunologically inferior to 2 and 3 doses, is as effective at preventing persistent infection with vaccine HPV types at least for 7-10 years. To address the issue of alternative dosage schedules that include 1 dose either as a single dose or extended 1 + 1 with the second dose 3-5 years post-first dose are under investigation in RCTs.Expert opinion: Since, in the short term, vaccine supplies are constrained and will impact on the ability of countries to implement HPV vaccine programs: the challenges and opportunities of the alternative approaches in this scenario are discussed.
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Latsuzbaia A, Arbyn M, Tapp J, Fischer M, Weyers S, Pesch P, Mossong J. Effectiveness of bivalent and quadrivalent human papillomavirus vaccination in Luxembourg. Cancer Epidemiol 2019; 63:101593. [DOI: 10.1016/j.canep.2019.101593] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/17/2023]
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Monitoring human papillomavirus prevalence among young Australian women undergoing routine chlamydia screening. Vaccine 2019; 38:1186-1193. [PMID: 31767467 DOI: 10.1016/j.vaccine.2019.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Australia has recently implemented major changes in cervical cancer prevention policies including introduction of primary human papillomavirus (HPV) screening starting at age 25, and replacement of the quadrivalent HPV vaccine with the nonavalent vaccine in the national school-based program. We assessed the feasibility and utility of conducting HPV testing in residual clinical specimens submitted for routine Chlamydia trachomatis screening, as a means of tracking HPV vaccine program impact among young sexually active women. METHODS De-identified residual specimens from women aged 16-24 years submitted for chlamydia testing were collected from three pathology laboratories in Victoria and New South Wales. Limited demographic information, and chlamydia test results were also collected. Patient identifiers were sent directly from the laboratories to the National HPV Vaccination Program Register, to obtain HPV vaccination histories. Samples underwent HPV genotyping using Seegene Anyplex II HPV 28 assay. RESULTS Between April and July 2018, 362 residual samples were collected, the majority (60.2%) of which were cervical swabs. Demographic data and vaccination histories were received for 357 (98.6%) women (mean age 21.8, SD 2.0). Overall, 65.6% of women were fully vaccinated, 9.8% partially, and 24.7% unvaccinated. The majority (86.0%) resided in a major city, 35.9% were classified in the upper quintile of socioeconomic advantage and chlamydia positivity was 7.8%.The prevalence of quadrivalent vaccine-targeted types (HPV6/11/16/18) was 2.8% (1.5-5.1%) overall with no differences by vaccination status (p = 0.729). The prevalence of additional nonavalent vaccine-targeted types (HPV31/33/45/52/58) was 19.3% (15.6-23.8%). One or more oncogenic HPV types were detected in 46.8% (95% CI 41.6-52.0%) of women. CONCLUSIONS HPV testing of residual chlamydia specimens provides a simple, feasible method for monitoring circulating genotypes. Applied on a larger scale this method can be utilised to obtain a timely assessment of nonavalent vaccine impact among young women not yet eligible for cervical screening.
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Hull B, Hendry A, Dey A, Brotherton J, Macartney K, Beard F. Annual Immunisation Coverage Report 2017. ACTA ACUST UNITED AC 2019; 43. [PMID: 31738865 DOI: 10.33321/cdi.2019.43.47] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This eleventh national annual immunisation coverage report focuses on data for the calendar year 2017 derived from the Australian Immunisation Register (AIR) and the National Human Papillomavirus (HPV) Vaccination Program Register. This is the first report to include data on HPV vaccine course completion in Aboriginal and Torres Strait Islander (Indigenous) adolescents. 'Fully immunised' vaccination coverage in 2017 increased at the 12-month assessment age reaching 93.8% in December 2017, and at the 60-month assessment age reaching 94.5%. 'Fully immunised' coverage at the 24-month assessment age decreased slightly to 89.8% in December 2017, following amendment in December 2016 to require the fourth DTPa vaccine dose at 18 months. 'Fully immunised' coverage at 12 and 60 months of age in Indigenous children reached the highest ever recorded levels of 93.2% and 96.9% in December 2017. Catch-up vaccination activity for the second dose of measles-mumps-rubella-containing vaccine was considerably higher in 2017 for Indigenous compared to non-Indigenous adolescents aged 10-19 years (20.3% vs. 6.4%, respectively, of those who had not previously received that dose). In 2017, 80.2% of females and 75.9% of males aged 15 years had received a full course of three doses of human papillomavirus (HPV) vaccine. Of those who received dose one, 79% and 77% respectively of Indigenous girls and boys aged 15 years in 2017 completed three doses, compared to 91% and 90% of non-Indigenous girls and boys, respectively. A separate future report is planned to present adult AIR data and to assess completeness of reporting.
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Affiliation(s)
- Brynley Hull
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, Locked Bag 4001, Westmead, NSW 2145
| | - Alexandra Hendry
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, Locked Bag 4001, Westmead, NSW 2145
| | - Aditi Dey
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, Locked Bag 4001, Westmead, NSW 2145
| | - Julia Brotherton
- National HPV Vaccination Program Register, VCS Foundation, PO Box 310, East Melbourne, Vic 8002
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, Locked Bag 4001, Westmead, NSW 2145
| | - Frank Beard
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and University of Sydney, Locked Bag 4001, Westmead, NSW 2145
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Kudo R, Yamaguchi M, Sekine M, Adachi S, Ueda Y, Miyagi E, Hara M, Hanley SJB, Enomoto T. Bivalent Human Papillomavirus Vaccine Effectiveness in a Japanese Population: High Vaccine-Type-Specific Effectiveness and Evidence of Cross-Protection. J Infect Dis 2019; 219:382-390. [PMID: 30299519 PMCID: PMC6325350 DOI: 10.1093/infdis/jiy516] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/03/2018] [Indexed: 01/22/2023] Open
Abstract
Background Proactive recommendations for human papillomavirus (HPV) vaccines in Japan have been suspended for 5 years because of safety concerns. While no scientific evidence exists to substantiate these concerns, one reason given for not reinstating recommendations is the lack of reliable vaccine effectiveness (VE) data in a Japanese population. This study reports the VE of the bivalent HPV vaccine in Japanese women aged 20–22 years. Methods During cervical screening between 2014 and 2016, women had Papanicolaou smears and HPV tests performed and provided data about their sexual history. Estimates of VE for vaccine-targeted HPV type 16 (HPV16) and 18 and cross-protection against other types were calculated. Results Overall, 2197 women were tested, and 1814 were included in the analysis. Of these, 1355 (74.6%) were vaccinated, and 1295 (95.5%) completed the 3-dose schedule. In women sexually naive at vaccination, the pooled VEs against HPV16 and 18 and for HPV31, 45, and 52 were 95.5% (P < .01) and 71.9% (P < .01), respectively. When adjusted for number of sex partners and birth year, pooled VEs were 93.9% (P = .01) and 67.7% (P = .01) for HPV16 and 18 and HPV31, 45, and 52, respectively. Conclusions The bivalent HPV vaccine is highly effective against HPV16 and 18. Furthermore, significant cross-protection against HPV31, 45, and 52 was demonstrated and sustained up to 6 years after vaccination. These findings should reassure politicians about the VE of bivalent HPV vaccine in a Japanese population.
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Affiliation(s)
- Risa Kudo
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Manako Yamaguchi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Sekine
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sosuke Adachi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yutaka Ueda
- Departments of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Sharon J B Hanley
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Walduck AK, Raghavan S. Immunity and Vaccine Development Against Helicobacter pylori. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1149:257-275. [PMID: 31016627 DOI: 10.1007/5584_2019_370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Helicobacter pylori is a highly-adapted gastrointestinal pathogen of humans and the immunology of this chronic infection is extremely complex. Despite the availability of antibiotic therapy, the global incidence of H. pylori infection remains high, particularly in low to middle-income nations. Failure of therapy and the spread of antibiotic resistance among the bacteria are significant problems and provide impetus for the development of new therapies and vaccines to treat or prevent gastric ulcer, and gastric carcinoma. The expansion of knowledge on gastric conventional and regulatory T cell responses, and the role of TH17 in chronic gastritis from studies in mouse models and patients have provided valuable insights into how gastritis is initiated and maintained. The development of human challenge models for testing candidate vaccines has meant a unique opportunity to study acute infection, but the field of vaccine development has not progressed as rapidly as anticipated. One clear lesson learned from previous studies is that we need a better understanding of the immune suppressive mechanisms in vivo to be able to design vaccine strategies. There is still an urgent need to identify practical surrogate markers of protection that could be deployed in future field vaccine trials. Important developments in our understanding of the chronic inflammatory response, progress and problems arising from human studies, and an outlook for the future of clinical vaccine trials will be discussed.
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Affiliation(s)
- Anna K Walduck
- School of Science, RMIT University, Melbourne, VIC, Australia.
| | - Sukanya Raghavan
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
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Dodd RH, Nickel B, Wortley S, Bonner C, Hersch J, McCaffery KJ. Examining the information needed for acceptance of deintensified screening programmes: qualitative focus groups about cervical screening in Australia. BMJ Open 2019; 9:e029319. [PMID: 31630103 PMCID: PMC6803149 DOI: 10.1136/bmjopen-2019-029319] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Given the changing understanding of overdiagnosis of screen detected cancers and advances in technology to detect and prevent cancer, updating and scaling back cancer screening programmes is becoming increasingly necessary. The National Cervical Screening Programme (NCSP) in Australia was recently deintensified, with the changes implemented in December 2017. This study examines women's understanding and acceptance of the renewed screening protocol and how such changes can be communicated more effectively. DESIGN Focus groups structured around a presentation of information about the renewed NCSP, with discussions of the information facilitated throughout. Qualitative data analysis was conducted. SETTING Australia PARTICIPANTS: Six focus groups were conducted in November 2017 with a community sample of 49 women aged 18-74. RESULTS Women demonstrated little or no awareness of the upcoming screening changes in the period just before they occurred. Women expressed most concern and fear that the increased screening interval (from 2 to 5 years) and later age of first screening (from age 18 to 25 years) could lead to missing cancers. Concerns about exit testing were less common. Understanding of the natural history and the prevalence of both human papillomavirus and cervical cancer, and the nature of the new test (catching it 'earlier') was key to alleviate concerns about the increased screening interval. CONCLUSIONS Deintensifying screening programmes should be accompanied by clear and coherent communication of the changes, including the rationale behind them, to limit concerns from the public and facilitate acceptance of renewed programmes. In this case, understanding the biology of cervical cancer was crucial.
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Affiliation(s)
- Rachael H Dodd
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sally Wortley
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jolyn Hersch
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten J McCaffery
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Widdice LE, Bernstein DI, Franco EL, Ding L, Brown DR, Ermel AC, Higgins L, Kahn JA. Decline in vaccine-type human papillomavirus prevalence in young men from a Midwest metropolitan area of the United States over the six years after vaccine introduction. Vaccine 2019; 37:6832-6841. [PMID: 31582269 DOI: 10.1016/j.vaccine.2019.08.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to determine changes in human papillomavirus (HPV) prevalence among young men from a Midwest metropolitan area over the six years after vaccine introduction, including HPV prevalence in men overall, in vaccinated men to examine vaccine impact and in unvaccinated men to examine herd protection. An exploratory aim was to examine associations between number of vaccine doses and HPV prevalence. METHODS Men aged 14-26 years reporting male-female and/or male-male sexual contact were recruited from a primary care clinic, sexually transmitted disease clinic, and community setting during two waves of data collection: 2013-2014 (N = 400) and 2016-2017 (N = 347). Participants completed a questionnaire and were tested for penile, scrotal and anal HPV. Changes in prevalence of any (≥1 type) and vaccine-type HPV (HPV6, 11, 16, and/or 18) were examined using propensity score weighted logistic regression. Associations between number of doses and HPV infection were determined using chi-square tests and logistic regression. RESULTS The proportion of men with a history of ≥1 HPV vaccine doses increased from 23% to 44% (p < 0.001) from waves 1 to 2. After propensity score weighting, infection with ≥1 vaccine-type HPV significantly decreased among all men (29% to 20%; 31% decrease; odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.44-0.88) and unvaccinated men (32% to 21%; 36% decrease; OR = 0.56, 95%CI = 0.34-0.86); there was a non-significant decrease (21%) among vaccinated men. Associations between number of doses and HPV prevalence were not statistically significant. CONCLUSIONS Prevalence of vaccine-type HPV decreased among all, vaccinated, and unvaccinated men six years after HPV vaccine recommendation, supporting vaccine impact and herd protection. Decreases in vaccine-type HPV in all men appear to be due to decreases in unvaccinated men, suggesting that the full impact of vaccination has yet to be realized. Continued monitoring and efforts to vaccinate men prior to sexual initiation are warranted.
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Affiliation(s)
- Lea E Widdice
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - David I Bernstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - Eduardo L Franco
- Department of Oncology and Department of Epidemiology & Biostatistics, McGill University, Faculty of Medicine, 5100 Maisonneuve Blvd West, Suite 720, Montreal, QC H4A3T2, Canada.
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - Darron R Brown
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, 635 Barnhill Dr., Van Nuys Medical Sciences Building, Suite 224, Indianapolis, IN 46202, USA.
| | - Aaron C Ermel
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, 635 Barnhill Dr., Van Nuys Medical Sciences Building, Suite 224, Indianapolis, IN 46202, USA.
| | - Lisa Higgins
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - Jessica A Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
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Gredner T, Behrens G, Stock C, Brenner H, Mons U. Cancers Due to Infection and Selected Environmental Factors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:586-593. [PMID: 30236218 DOI: 10.3238/arztebl.2018.0586] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 04/16/2018] [Accepted: 07/10/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Causal relationships with the occurrence of cancer have been established for a number of infections and environmental risk factors. METHODS Numbers and proportions (population-attributable fractions, PAF) of cancer cases attributable to these factors in Germany were calculated by sex and age groups for ages 35 to 84 years based on population projections, national cancer incidence, exposure data, and published risk estimates. RESULTS For 2018, more than 17 600 cancer cases (4.0% of all incident cancers) were estimated to be attributable to infections. The largest contributions come from Helicobacter pylori (n = 8764) and human papillomavirus (n = 7669) infections. Infection with hepatitis B and C, human immunodeficiency virus, and human herpesvirus 8 were estimated to cause 983 cases, 144 cases, and 116 cases, respectively. More than 5400 cancer cases (1.2% of all incident cancers) were estimated to be attributable to selected environmental factors, of which the largest contributor is indoor radon (n = 3185), followed by particulate matter (n = 1049), sunbed use (n = 892), and secondhand smoke (n = 309). CONCLUSION Of all cancers expected in 2018 in Germany, at least 5% are attributable to potentially avoidable infections and environmental factors. Further research should be directed towards more comprehensive identification and quantification of environmental risks as a basis for targeted cancer prevention.
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Affiliation(s)
- Thomas Gredner
- * Joint last authors; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg; Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg
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Patel C, Brotherton JM, Pillsbury A, Jayasinghe S, Donovan B, Macartney K, Marshall H. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? ACTA ACUST UNITED AC 2019; 23. [PMID: 30326995 PMCID: PMC6194907 DOI: 10.2807/1560-7917.es.2018.23.41.1700737] [Citation(s) in RCA: 157] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: A National human papilloma virus (HPV) Vaccination Programme for the prevention of HPV infection and associated disease using the quadrivalent HPV vaccine (4vHPV) has been funded and implemented in Australia since 2007, initially for girls only and extended to boys in 2013, with uptake rates among the highest observed worldwide. Aim: We report on the impact of this national programme on HPV prevalence and associated disease burden and estimate the potential impact of adopting a nonavalent HPV (9vHPV) vaccine. Methods: We performed a non-systematic literature review of studies measuring the burden of HPV-associated disease and infection in Australia before and after introduction of HPV vaccination. We also included key national reports with estimates of HPV-related disease burden. Results: Substantial declines in high-grade cervical disease and genital warts among vaccine-eligible women have been observed. Reductions in genital warts incidence and HPV prevalence among heterosexual men of similar age were observed before introduction of the male vaccination programme, indicating a substantial herd effect. 9vHPV vaccine is expected to prevent up to 90% of cervical and 96% of anal cancers. Of an estimated 1,544 HPV-associated cancers in 2012, 1,242 would have been preventable by the 4vHPV vaccine and an additional 187 anogenital cancers by the 9vHPV vaccine. Conclusions: Vaccination using 4vHPV vaccine has had a large demonstrable impact on HPV-related disease in Australia. A switch to 9vHPV could further reduce the HPV-associated cancer burden. With continued high coverage among both males and females, elimination of vaccine-type HPV disease seems achievable in Australia.
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Affiliation(s)
- Cyra Patel
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Julia Ml Brotherton
- School of Population and Global Health, University of Melbourne, Parkville, Australia.,VCS Population Health, VCS Foundation, East Melbourne, Australia
| | - Alexis Pillsbury
- National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Sanjay Jayasinghe
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Basil Donovan
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.,The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kristine Macartney
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,National Centre for Immunisation Research and Surveillance, Westmead, Australia
| | - Helen Marshall
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, North Adelaide, Australia.,Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, North Adelaide, Australia
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65
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Ioannides S, Beard F, Larter N, Clark K, Wang H, Hendry A, Hull B, Dey A, Chiu C, Brotherton J, Jayasinghe S, Macartney K, McIntyre P. Vaccine Preventable Diseases and Vaccination Coverage in Aboriginal and Torres Strait Islander People, Australia, 2011–2015. Commun Dis Intell (2018) 2019. [DOI: 10.33321/cdi.2019.43.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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66
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Drolet M, Bénard É, Pérez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019; 394:497-509. [PMID: 31255301 PMCID: PMC7316527 DOI: 10.1016/s0140-6736(19)30298-3] [Citation(s) in RCA: 542] [Impact Index Per Article: 108.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination. METHODS In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks. FINDINGS We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5-8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11-0·25) among girls aged 13-19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23-0·49) among women aged 20-24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33-0·66) among girls aged 13-19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24-0·46) among girls aged 15-19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36-0.60) among women aged 20-24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53-0·89) among women aged 25-29 years. Among boys aged 15-19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37-0·75) and among men aged 20-24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47-0·98). After 5-9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42-0·58) among screened girls aged 15-19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57-0·84) among women aged 20-24 years. INTERPRETATION This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects. FUNDING WHO, Canadian Institutes of Health Research, Fonds de recherche du Québec - Santé.
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Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Élodie Bénard
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Norma Pérez
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
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Toh ZQ, Kosasih J, Russell FM, Garland SM, Mulholland EK, Licciardi PV. Recombinant human papillomavirus nonavalent vaccine in the prevention of cancers caused by human papillomavirus. Infect Drug Resist 2019; 12:1951-1967. [PMID: 31308715 PMCID: PMC6613616 DOI: 10.2147/idr.s178381] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/26/2019] [Indexed: 12/26/2022] Open
Abstract
Human papillomavirus (HPV) types 16 and 18 cause 70% of cervical cancer cases globally. The nonavalent HPV vaccine (9vHPV) was licensed in 2014 and protects against the next five most common cancer-causing HPV types (HPV 31/33/45/52/58) after HPV 16/18. Phase III clinical studies have demonstrated high vaccine efficacy (>90%) against cervical, vulvar, and vaginal precancers caused by these additional types, and have shown comparable immunogenicity to the shared genotypes to quadrivalent HPV vaccine (4vHPV). Vaccine efficacy and antibody responses for 9vHPV are found to persist for at least five years while longer-term observational studies are ongoing to monitor long-term vaccine effectiveness. The implementation of 9vHPV has the potential to prevent up to 93% of cervical cancer cases, as well as a significant proportion of other HPV-related anogenital cancers. This review article summarizes the current evidence for 9vHPV in terms of vaccine efficacy against HPV infection and related anogenital precancers, safety, and immunogenicity, as well as discussing the potential impact of this vaccine on the cervical cancer burden globally.
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Affiliation(s)
- Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennie Kosasih
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Regional WHO HPV Reference Laboratory, Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Edward K Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, University of London, London WC1E7HT, UK
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Feder MA, Kulasingam SL, Kiviat NB, Mao C, Nelson EJ, Winer RL, Whitham HK, Lin J, Hawes SE. Correlates of Human Papillomavirus Vaccination and Association with HPV-16 and HPV-18 DNA Detection in Young Women. J Womens Health (Larchmt) 2019; 28:1428-1435. [PMID: 31264912 DOI: 10.1089/jwh.2018.7340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Despite a reduction in the prevalence of vaccine-preventable types of human papillomavirus (HPV), attributed to increased HPV vaccine uptake, HPV continues to be a major cause of cancer in the United States. Methods: We assessed factors associated with self-reported HPV vaccine uptake, HPV vaccination effectiveness, using DNA testing to assess HPV types 16 and/or 18 (HPV 16/18) positivity, and patterns of HPV vaccination in 375 women aged 21-29 years who were eligible to receive catch-up vaccination, using baseline data collected from March 2012 to December 2014 from a randomized controlled trial evaluating a novel approach to cervical cancer screening. Results: More than half (n = 228, 60.8%) of participants reported receipt of at least one HPV vaccine dose and 16 (4.3%) tested positive for HPV 16/18 at baseline. College-educated participants were four times more likely to have been vaccinated than those reporting high school education or less. 56.5% of HPV-vaccinated participants reported first dose after age 18 and 68.4% after first vaginal intercourse. Women vaccinated after age 18 and women vaccinated after first vaginal intercourse were somewhat more likely to be infected with HPV 16/18 infection compared with women vaccinated earlier, but these associations did not reach statistical significance. Conclusions: HPV vaccination is common among college-educated women in the catch-up population but less common among those without college education. Contrary to current guidelines, catch-up females frequently obtain HPV vaccination after age 18 and first vaginal intercourse. Women without a college education represent an ideal population for targeted HPV vaccination efforts that emphasize vaccination before sexual debut.
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Affiliation(s)
- Molly A Feder
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Shalini L Kulasingam
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Nancy B Kiviat
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington
| | - Constance Mao
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Erik J Nelson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana
| | - Rachel L Winer
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Hilary K Whitham
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - John Lin
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
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69
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Batmunkh T, von Mollendorf C, Tulgaa K, Surenjav U, Dalmau MT, Namjil N, Tsedevdamba B, Tsegmed S, Enkhmaa J, Garland SM, Mulholland K. HPV genoprevalence and HPV knowledge in young women in Mongolia, five years following a pilot 4vHPV vaccination campaign. ACTA ACUST UNITED AC 2019; 8:100175. [PMID: 31276802 PMCID: PMC6658929 DOI: 10.1016/j.pvr.2019.100175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND In a 2012 pilot, 9111 Mongolian girls aged 11-17 years received three doses of the quadrivalent (4vHPV) vaccine, Gardasil®. This is the first study to measure early vaccine effectiveness and assess knowledge and attitudes of young women in Mongolia in relation to the human papillomavirus (HPV), the vaccine and cervical cancer. METHODS A cohort of women vaccinated in 2012 (n = 726) and an unvaccinated cohort (n = 790) provided self-administered vaginal swabs for detection of high-risk HPV genotypes 16, 18/45, 31, 33, 35, 39, 51, 52, 56, 58, 59, 66, 68 five years following vaccination. Participant knowledge and attitudes were assessed through a questionnaire. RESULTS A total of 1882 questionnaires and 1516 self-administered vaginal swabs were analyzed. The prevalence of any HRHPV was 39.5% among both cohorts. The prevalence of vaccine-targeted HPV types was significantly lower in the vaccinated cohort than unvaccinated: 4.8% and 17.2% respectively. The 4vHPV was shown to be protective against HRHPV 16, 18/45 with 75% vaccine effectiveness. Participant knowledge was low. CONCLUSIONS This study demonstrates that the 4vHPV is associated with reduced vaccine-targeted HPV detection rates in young Mongolian women. The questionnaire results highlight a need for awareness-raising initiatives in Mongolia on HPV, the vaccine and cervical cancer.
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Affiliation(s)
- Tsetsegsaikhan Batmunkh
- National Cancer Council of Mongolia, #101, Oyutnii Khotkhon 68/1, Bayanzurkh District, Ulaanbaatar, Mongolia.
| | - Claire von Mollendorf
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia
| | - Khosbayar Tulgaa
- Mongolian National University of Medical Sciences, Jamyan Street 3, Ulaanbaatar, Mongolia
| | | | - Marguerite T Dalmau
- National Cancer Council of Mongolia, #101, Oyutnii Khotkhon 68/1, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Narantuya Namjil
- Onoshmed Laboratory, Khatagtai Hospital, Sukhbaatar District, Ulaanbaatar, Mongolia
| | - Battsetseg Tsedevdamba
- National Cancer Council of Mongolia, #101, Oyutnii Khotkhon 68/1, Bayanzurkh District, Ulaanbaatar, Mongolia
| | - Sambuu Tsegmed
- National Center for Public Health, Olympic Street 2, Ulaanbaatar, Mongolia
| | - Jalserd Enkhmaa
- Mongolian National University of Medical Sciences, Jamyan Street 3, Ulaanbaatar, Mongolia
| | - Suzanne M Garland
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Australia; Centre for Women's Infectious Diseases Research, Royal Women's Hospital, Parkville, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Melbourne, Australia
| | - Kim Mulholland
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Anal cancer risk: HPV-based cervical screening programmes. THE LANCET. INFECTIOUS DISEASES 2019; 19:799-800. [PMID: 31204305 DOI: 10.1016/s1473-3099(19)30296-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 01/04/2023]
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Machalek DA, Roberts JM, Garland SM, Thurloe J, Richards A, Chambers I, Sivertsen T, Farnsworth A. Routine cervical screening by primary HPV testing: early findings in the renewed National Cervical Screening Program. Med J Aust 2019; 211:113-119. [PMID: 31168828 DOI: 10.5694/mja2.50223] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To report human papillomavirus (HPV) testing patterns and rates of oncogenic HPV-positivity for specimens submitted during the first 6 months after the National Cervical Screening Program switched from cytology- to primary HPV-based screening. DESIGN, PARTICIPANTS Retrospective cross-sectional review of 195 606 specimens submitted for HPV testing, 1 December 2017 - 31 May 2018. SETTING Large community-based general pathology laboratory in metropolitan Sydney. MAIN OUTCOME MEASURES Prevalence of oncogenic HPV types (all, HPV16/18, non-HPV16/18) by reason for HPV test (primary screening, non-screening); for oncogenic HPV-positive women in the age band recommended for primary HPV screening (25-74 years), prevalence of cytologic abnormality and rates of 12-month follow-up and colposcopy recommendations. RESULTS 195 606 samples were received: 157 700 (80.6%) for primary screening, 37 906 (19.4%) for non-screening tests. Oncogenic HPV was detected in 8.1% of screening tests (95% CI, 7.9-8.2%) and 20.9% of non-screening tests (95% CI, 20.5-21.3%); 35.5% (95% CI, 34.7-36.4%) of women of recommended screening age with positive oncogenic HPV screening test results also had a cytologic abnormality. The proportion of HPV16/18-positive samples with high grade abnormality was 15.3% (95% CI, 14.2-16.6%); for samples positive for other oncogenic HPV types, the proportion was 6.3% (95% CI, 5.8-6.8%). Repeat HPV testing after 12 months was recommended for 5.4% (95% CI, 5.3-5.5%) and direct colposcopy for 2.6% (95% CI, 2.5-2.7%) of screened women aged 25-74 years. CONCLUSIONS High grade cytologic abnormalities were more common in women positive for HPV16/18, supporting their higher risk classification. Colposcopy referral rates were higher than during primary cytology-based testing, as predicted by clinical trial and modelling data. The prevalence of HPV was much higher in non-screening than in primary screening samples. Our findings indicate the renewed program is performing as expected during the initial HPV screening round.
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Affiliation(s)
- Dorothy A Machalek
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Suzanne M Garland
- Centre for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | | | | | | | - Annabelle Farnsworth
- Douglass Hanly Moir Pathology, Sydney, NSW.,University of Notre Dame, Sydney, NSW
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Aro K, Nieminen P, Louvanto K, Jakobsson M, Virtanen S, Lehtinen M, Dillner J, Kalliala I. Age-specific HPV type distribution in high-grade cervical disease in screened and unvaccinated women. Gynecol Oncol 2019; 154:354-359. [PMID: 31176553 DOI: 10.1016/j.ygyno.2019.05.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Age-specific type-distribution of high-risk human papillomavirus (hrHPV) in cervical precancerous lesions is subject to change in the HPV vaccination era. Knowing the pre-vaccination type-distribution helps to anticipate changes induced by mass vaccination and optimize screening. METHODS We recruited 1279 women referred to colposcopy for abnormal cytology into a population-based study on HPV type distribution in diagnostic cervical samples (ISRCTN10933736). The HPV genotyping findings were grouped as: HPV16/18+, other hrHPV+ (HPV31/33/35/39/45/51/52/56/58/59/66/68), non-vaccine targeted hrHPV+ (HPV35/39/51/56/59/66/68), low-risk HPV, and HPV negative. We estimated the HPV group-specific prevalence rates according to diagnostic histopathological findings in the age groups of <30 (n = 339), 30-44.9 (n = 614), and ≥45 (n = 326). RESULTS Altogether 503 cases with high grade squamous intraepithelial lesion or worse (HSIL+) were diagnosed. More than half, 285 (56.7%) of HSIL+ cases were associated with HPV16/18: 64.3% (101/157) in women <30 years (reference group), 58.4% (157/269) in women 30-44.9 years (risk ratio (RR) 0.91, 95% confidence interval (95% CI) 0.78-1.06), and 35.1% (27/77) in women ≥45 years of age (RR 0.55, 95% CI 0.39-0.75). Conversely, other hrHPV's were associated with 191 (38.0%) of HSIL+: 31.9% (50/157) in women <30, 36.8% (99/269) in women 30-44.9 years, 54.6% (42/77) and in women ≥45 (RR 1.71, 95% CI 1.26-2.33). The proportion of non-vaccine targeted hrHPV and HPV negative HSIL+ increased with advancing age. CONCLUSIONS Pre-vaccination HPV type distribution in HSIL+ was distinctly polarised by age with HPV16/18 attributed disease being markedly more prevalent in women aged <30. In the older women the other hrHPV types, however, dominated suggesting a need for more age-dependent screening strategies.
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Affiliation(s)
- Karoliina Aro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Karolina Louvanto
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Maija Jakobsson
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Seppo Virtanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
| | - Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, SE-171 77 Stockholm, Sweden.
| | - Ilkka Kalliala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 2, 00290 Helsinki, Finland.
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Castillo A, Osorio JC, Fernández A, Méndez F, Alarcón L, Arturo G, Herrero R, Bravo LE. Effect of vaccination against oral HPV-16 infection in high school students in the city of Cali, Colombia. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2019; 7:112-117. [PMID: 30851448 PMCID: PMC6416654 DOI: 10.1016/j.pvr.2019.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/10/2019] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In recent years, an association between HPV-16 and oropharyngeal cancers has been reported. Therefore, it is necessary to evaluate whether vaccination decreases the exposure of HPV-16 in the oral cavity. OBJECTIVE To evaluate the effect of vaccination on oral HPV-16 infection in high school students in the city of Cali, Colombia. METHODS In this cross-sectional study, HPV-16 DNA was detected in samples from the oral cavity and throat of 1,784 high school students of both genders, aged 14-17 years old, in 21 schools in the city of Cali, Colombia. The number in vaccinated girls were 944 vs., 95 unvaccinated girls and 745 unvaccinated boys. RESULTS The HPV exposure percentages were: 0.7% in vaccinated girls, 3.2% in unvaccinated girls and 2.3% in unvaccinated boys. The odds ratio (OR) of detection of HPV-16 in vaccinated versus unvaccinated students was 0.28 (95% CI: 0.07-0.88), representing a 72% reduction in HPV-16 detection in students immunized with two doses. The odds of detection of HPV-16 in unvaccinated male students were 3.6 times those of vaccinated girls (OR = 3.6, 95% CI: 1.21-12.81) and increased to almost eight-fold in boys who had initiated sexual activity (OR = 7.74, 95% CI: 1.53-75.09). CONCLUSIONS HPV vaccination was associated with the reduction of HPV-16 exposure percentages in the oral and oropharyngeal cavity.
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Affiliation(s)
- Andres Castillo
- Department of Biology, School of Natural and Exact Sciences, Universidad del Valle, Colombia.
| | - Julio Cesar Osorio
- Doctoral Program in Biomedical Sciences, School of Basic Sciences, Universidad del Valle, Cali, Colombia
| | - Adrián Fernández
- Master's Program in Epidemiology, School of Public Health, Universidad del Valle, Cali, Colombia
| | - Fabián Méndez
- Master's Program in Epidemiology, School of Public Health, Universidad del Valle, Cali, Colombia
| | - Liliana Alarcón
- Expanded Program on Immunization, Municipal Public Health Secretariat of Cali, Colombia
| | - Gabriela Arturo
- Expanded Program on Immunization, Municipal Public Health Secretariat of Cali, Colombia
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Luis Eduardo Bravo
- Population Registry of Cali, Department of Pathology, Universidad del Valle, Cali, Colombia
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Pathways to a cancer-free future: A protocol for modelled evaluations to maximize the future impact of interventions on cervical cancer in Australia. Gynecol Oncol 2019; 152:465-471. [PMID: 30876490 DOI: 10.1016/j.ygyno.2018.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/05/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Australia's HPV vaccination and HPV-based cervical screening programs are changing the landscape in cervical cancer prevention. We aim to identify areas which can make the biggest further impact on cervical cancer burden. This protocol describes the first stage of a program of work called Pathways-Cervix that aims to generate evidence from modelled evaluations of interventions across the cervical cancer spectrum. METHODS Based on evidence from literature reviews and guidance from a multi-disciplinary Scientific Advisory Committee (SAC), the most relevant evaluations for prevention, diagnosis and treatment were identified. RESULTS Priority evaluations agreed by the SAC included: increasing/decreasing and retaining vaccination uptake at the current level; vaccinating older women; increasing screening participation; methods for triaging HPV-positive women; improving the diagnosis of cervical intraepithelial neoplasia (CIN) and cancer; treating cervical abnormalities and cancer; and vaccinating women treated for CIN2/3 to prevent recurrence. Evaluations will be performed using a simulation model, Policy1-Cervix previously used to perform policy evaluations in Australia. Exploratory modelling of interventions using idealised scenarios will initially be conducted in single birth cohorts. If these have a significant impact on findings then evaluations with more realistic assumptions will be conducted. Promising strategies will be investigated further by multi-cohort simulations predicting health outcomes, resource use and cost outcomes. CONCLUSIONS Pathways-Cervix will assess the relative benefits of strategies and treatment options in a systematic and health economic framework, producing a list of 'best buys' for future decision-making in cervical cancer control.
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Zeng Y, Moscicki AB, Sahasrabuddhe VV, Garcia F, Woo H, Hsu CH, Szabo E, Dimond E, Vanzzini S, Mondragon A, Butler V, DeRose H, Chow HHS. A prospective, single-arm, open-label, non-randomized, phase IIa trial of a nonavalent prophylactic HPV vaccine to assess immunogenicity of a prime and deferred-booster dosing schedule among 9-11 year-old girls and boys - clinical protocol. BMC Cancer 2019; 19:290. [PMID: 30935375 PMCID: PMC6444524 DOI: 10.1186/s12885-019-5444-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/07/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines are indicated for the prevention of cancers and genital warts caused by vaccine-covered HPV types. Although the standard regimen requires a two or three-dose vaccine series, there is emerging data suggesting that a single dose of the bivalent or quadrivalent HPV vaccine generates persistently positive antibody titers. No similar data is yet available for the nonavalent HPV vaccine, currently the only HPV vaccine available in the United States. The overall objective of our study is to assess the stability and kinetics of antibody titers for 24 months following a single dose of the nonavalent HPV vaccine among preteen girls and boys. METHODS This is a prospective, single-arm, open-label, non-randomized, Phase IIa trial among 9-11 year-old girls and boys to determine the immunogenicity after a single dose of the nonavalent HPV vaccine (GARDASIL® 9) over 24 months, with a deferred booster dose at 24 months and an optional booster at 30 months after the first dose. Participants provide blood specimens at 6, 12, 18, 24, and 30 months after the first dose. Serologic geometric mean titers (GMT) of the nine vaccine types (HPV 16/18/ 6/11/31/33/45/52/58) will be measured at each time point. The primary objective is to determine the stability of type-specific serologic GMT of HPV16 and HPV18 between the 6- vs. 12-month, 12- vs. 18-month, and 18- vs. 24-month visits. Secondary objectives are to determine the stability of type-specific serologic GMT of the other HPV types (HPV 6/11/31/33/45/52/58) between the visits and to assess safety and reactogenicity after each vaccine dose. DISCUSSION Single dose HPV vaccination could simplify the logistics and reduce costs of HPV vaccination in the US and across the world. This study will contribute important immunogenicity data on the stability and kinetics of type-specific antibody titers and inform feasibility of the single dose HPV vaccination paradigm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02568566 . Registered on October 6, 2015.
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Affiliation(s)
- Yi Zeng
- The University of Arizona Cancer Center, 1515 N Campbell Ave, Tucson, AZ 85724 USA
| | | | | | | | - Heide Woo
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA USA
| | - Chiu-Hsieh Hsu
- The University of Arizona Cancer Center, 1515 N Campbell Ave, Tucson, AZ 85724 USA
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD USA
| | - Eileen Dimond
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD USA
| | - Susan Vanzzini
- The University of Arizona Cancer Center, 1515 N Campbell Ave, Tucson, AZ 85724 USA
| | - Angelica Mondragon
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA USA
| | - Valerie Butler
- The University of Arizona Cancer Center, 1515 N Campbell Ave, Tucson, AZ 85724 USA
| | - Hillary DeRose
- The University of Arizona Cancer Center, 1515 N Campbell Ave, Tucson, AZ 85724 USA
| | - H.-H. Sherry Chow
- The University of Arizona Cancer Center, 1515 N Campbell Ave, Tucson, AZ 85724 USA
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Ährlund-Richter A, Cheng L, Hu YOO, Svensson M, Pennhag AAL, Ursu RG, Haeggblom L, Grün N, Ramqvist T, Engstrand L, Dalianis T, Du J. Changes in Cervical Human Papillomavirus (HPV) Prevalence at a Youth Clinic in Stockholm, Sweden, a Decade After the Introduction of the HPV Vaccine. Front Cell Infect Microbiol 2019; 9:59. [PMID: 30949454 PMCID: PMC6435486 DOI: 10.3389/fcimb.2019.00059] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 12/21/2022] Open
Abstract
Aim: This study aimed to follow the impact of human papillomavirus (HPV) catch-up and vaccination on the very high cervical HPV-prevalence in women at a youth clinic in central Stockholm during the period 2008–2018. Background: 2008–2010, cervical HPV-prevalence (69.5%) and HPV16 prevalence (34.7%) were high in non-vaccinated women at a youth clinic in Stockholm. 2013–2015, after the introduction of the quadrivalent-Gardasil® HPV-vaccine, HPV16 and HPV6 prevalence had decreased. Here, cervical HPV-prevalence was investigated 10 years after primary sampling. Material and Methods: 2017–2018, 178 cervical swabs, from women aged 15–23 years old, were tested for 27 HPV types by a bead-based multiplex method. HPV-prevalence data were then related to vaccination status and age and compared to HPV-prevalence in 615 samples from 2008 to 2010 and 338 samples from 2013 to 2015 from the same clinic, and to HPV types in 143 cervical cancer cases during 2003–2008 in Stockholm. Results: The proportion of vaccinated women increased from 10.7% (2008–2010) to 82.1% (2017–2018). The prevalence of all 27 HPVs, all high-risk HPVs (HR-HPVs) and the combined presence of the quadrivalent-Gardasil® types HPV16, 18, 6, and 11, was lower in vaccinated compared to unvaccinated women (67.4 vs. 93.3%, p = 0.0031, 60.1 vs. 86.7%, p = 0.0057 and 5.8 vs. 26.7%, p = 0.002, respectively). Furthermore, HPV16 prevalence in non-vaccinated women 2017–2018 was lower than that in 2008–2010 (16.7 and 34.7%, respectively, p = 0.0471) and similar trends were observed for HPV18 and 11. In both vaccinated and non-vaccinated women, the most common non-quadrivalent-Gardasil® vaccine HR-HPV types were HPV39, 51, 52, 56, and 59. Together they accounted for around 9.8% of cervical cancer cases in Stockholm during 2003–2008, and their prevalence tended to have increased during 2017–2018 compared to 2008–2010. Conclusion: Quadrivalent-Gardasil® vaccination has decreased HPV-vaccine type prevalence significantly. However, non-vaccine HR-HPV types remain high in potentially high-risk women at a youth clinic in Stockholm.
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Affiliation(s)
| | - Liqin Cheng
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden
| | - Yue O O Hu
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Mikaela Svensson
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden
| | - Alexandra A L Pennhag
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Ramona G Ursu
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Microbiology (Bacteriology, Virology) and Parasitology, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Linnea Haeggblom
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Engstrand
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Juan Du
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden
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Castle PE, Pierz A. (At Least) Once in Her Lifetime: Global Cervical Cancer Prevention. Obstet Gynecol Clin North Am 2019; 46:107-123. [DOI: 10.1016/j.ogc.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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78
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Dempsey AF. Three Important Findings From a Study on HPV "Real World" Effectiveness. Pediatrics 2019; 143:peds.2018-3427. [PMID: 30670583 DOI: 10.1542/peds.2018-3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Amanda F Dempsey
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Denver, Denver, Colorado
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79
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Spinner C, Ding L, Bernstein DI, Brown DR, Franco EL, Covert C, Kahn JA. Human Papillomavirus Vaccine Effectiveness and Herd Protection in Young Women. Pediatrics 2019; 143:peds.2018-1902. [PMID: 30670582 PMCID: PMC6361347 DOI: 10.1542/peds.2018-1902] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Clinical trials of the 4-valent human papillomavirus (HPV) vaccine demonstrate high efficacy, but surveillance studies are essential to examine the long-term impact of vaccine introduction on HPV prevalence in community settings. The aims of this study were to determine during the 11 years after vaccine introduction the prevalence of (1) vaccine-type HPV in adolescent and young adult women who were vaccinated (to assess vaccine effectiveness) and (2) vaccine-type HPV in women who were unvaccinated (to assess herd protection). METHODS Young women 13 to 26 years of age were recruited from hospital-based and community health clinics for 4 surveillance studies from 2006 to 2017. We determined the proportion of vaccinated and unvaccinated women who were positive for vaccine-type HPV across the studies, and the odds of positivity for vaccine-type HPV using logistic regression; all analyses were propensity score-adjusted to control for between-wave differences in participant characteristics. RESULTS Vaccination rates increased from 0% to 84.3% (97% of study participants received the 4-valent vaccine). Among women who were vaccinated, 4-valent vaccine-type HPV detection decreased from 35% to 6.7% (80.9% decline; odds ratio 0.13, 95% confidence interval 0.08 to 0.22). Among women who were unvaccinated, 4-valent vaccine-type HPV detection decreased from 32.4% to 19.4% (40% decline; odds ratio 0.50, 95% confidence interval 0.26 to 0.97). Estimated vaccine effectiveness was 90.6% in wave 3 and 80.1% in wave 4. CONCLUSIONS In this study in which trends in HPV in a US community >10 years after 4-valent HPV vaccine introduction and after 9-valent vaccine introduction were examined, we found evidence of vaccine effectiveness and herd protection. Further research is needed to examine trends in 9-valent vaccine-type HPV after higher rates of vaccination are achieved.
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Affiliation(s)
| | - Lili Ding
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - David I. Bernstein
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Courtney Covert
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jessica A. Kahn
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Egli-Gany D, Spaar Zographos A, Diebold J, Masserey Spicher V, Frey Tirri B, Heusser R, Dillner J, Petignat P, Sahli R, Low N. Human papillomavirus genotype distribution and socio-behavioural characteristics in women with cervical pre-cancer and cancer at the start of a human papillomavirus vaccination programme: the CIN3+ plus study. BMC Cancer 2019; 19:111. [PMID: 30700274 PMCID: PMC6354352 DOI: 10.1186/s12885-018-5248-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/26/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2008. To establish monitoring of the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to examine the distribution of oncogenic HPV genotypes in biopsies with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) at the beginning of HPV vaccination programmes and to compare sociodemographic and behavioural factors of women with CIN3+ with women in the Swiss general population. METHODS We conducted a retrospective and prospective cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status in the CIN3 + plus group with the Swiss National Cohort in 2014 and compared risk factors for HPV infection with the Swiss Health Survey in 2012. RESULTS We included 768 biopsies from 767 women. Four hundred and seventy-five (61.8%) biopsies were positive for HPV 16 and/or 18, 687 (89.5%) were positive for oncogenic HPV genotypes 16, 18, 31, 33, 45, 52, and/or 58 and five (0.7%) were HPV negative. Twenty-eight (10.3%) of the 273 women who completed the patient questionnaire reported having received at least one dose of an HPV vaccine. When compared with Swiss women in the six study cantons, fewer women in the CIN3+ plus study group were of Swiss nationality, more were born abroad and more were single. The study group also had a higher proportion of women with ≥2 partners in the last year, current smokers and was younger at age of first sexual intercourse. CONCLUSIONS Introduction of the nonavalent vaccine could cover approximately 90% of CIN3+ lesions in Swiss women compared with around 60% with the quadrivalent vaccine. Surveillance of HPV genotype distribution in CIN3+, together with information about vaccination and CIN3+ incidence will allow monitoring of the public health impact of vaccination programmes. TRIAL REGISTRATION ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014.
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Affiliation(s)
- Dianne Egli-Gany
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Anne Spaar Zographos
- Federal Office of Public Health, Schwarzenburgstrasse 157, 3003 Bern, Switzerland
| | - Joachim Diebold
- Institute of Pathology, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
| | | | - Brigitte Frey Tirri
- Department of Gynaecology and Obstetrics, Kantonsspital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Rolf Heusser
- National Institute for Cancer Epidemiology and Registration, Hirschengraben 82, 8001 Zurich, Switzerland
| | - Joakim Dillner
- WHO HPV LabNet Global Reference Laboratory, Department of Clinical Microbiology, Center for Cervical Cancer Prevention, Skåne University Hospital, Malmö, Karolinska Institute and Hospital, SE-171, 77 Stockholm, Sweden
| | - Patrick Petignat
- Department of Gynaecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Genève, Switzerland
| | - Roland Sahli
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 48, 1011 Lausanne, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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Sultana F, Winch K, Saville M, Brotherton JM. Is the positive predictive value of high‐grade cytology in predicting high‐grade cervical disease falling due to HPV vaccination? Int J Cancer 2019; 144:2964-2971. [DOI: 10.1002/ijc.32050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/22/2018] [Accepted: 11/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Farhana Sultana
- VCS Population HealthVCS Foundation East Melbourne VIC Australia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of Melbourne Carlton VIC Australia
| | - Karen Winch
- VCS Population HealthVCS Foundation East Melbourne VIC Australia
| | - Marion Saville
- VCS Population HealthVCS Foundation East Melbourne VIC Australia
- Department of Obstetrics and GynaecologyUniversity of Melbourne Parkville VIC Australia
| | - Julia M.L. Brotherton
- VCS Population HealthVCS Foundation East Melbourne VIC Australia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of Melbourne Carlton VIC Australia
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Hall MT, Simms KT, Lew JB, Smith MA, Brotherton JML, Saville M, Frazer IH, Canfell K. The projected timeframe until cervical cancer elimination in Australia: a modelling study. LANCET PUBLIC HEALTH 2019; 4:e19-e27. [DOI: 10.1016/s2468-2667(18)30183-x] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 02/03/2023]
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83
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Šterbenc A, Maver Vodičar P, Poljak M. Recent advances in prophylactic human papillomavirus (HPV) vaccination: a review of key literature published between September 2017 and September 2018. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brotherton JM, Hawkes D, Sultana F, Malloy MJ, Machalek DA, Smith MA, Garland SM, Saville M. Age-specific HPV prevalence among 116,052 women in Australia's renewed cervical screening program: A new tool for monitoring vaccine impact. Vaccine 2018; 37:412-416. [PMID: 30551987 DOI: 10.1016/j.vaccine.2018.11.075] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 11/20/2022]
Abstract
Australia's transition to primary human papillomavirus (HPV) based cervical screening, has for the first time, provided a passive mechanism for monitoring the impact of vaccination on infection prevalence among women attending screening. We assessed oncogenic HPV prevalence by single year of age in the first 7 months of the program, using data collected from a large screening laboratory in Victoria, Australia, which is routinely screening using cobas 4800, cobas 6800 and Seegene assays. Among 116,052 primary screening samples from women aged 25-74, 9.25% (95%CI: 9.09-9.42%) had oncogenic HPV detected: 2.14% (95%CI: 2.05-2.22%) were 16/18 positive and 7.12% (95%CI: 6.97-7.27%) were positive for only non-16/18 HPV. Prevalence peaked at age 25-29 then decreased with age, but this was driven by non-16/18 types. HPV16/18 prevalence remained low and flat across ages, contrasting with pre-vaccination epidemiology when HPV16/18 peaked in young women. HPV-based screening can precisely monitor HPV prevalence.
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Affiliation(s)
- Julia Ml Brotherton
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia.
| | - David Hawkes
- VCS Pathology, VCS Foundation, 265 Faraday Street, Carlton South, Victoria 3053, Australia; Department of Pharmacology and Therapeutics, The University of Melbourne, Victoria 3010, Australia.
| | - Farhana Sultana
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia.
| | - Michael J Malloy
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC, 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia.
| | - Dorothy A Machalek
- Melbourne School of Population and Global Health, University of Melbourne, Level 3, 207 Bouverie Street, Carlton, Victoria 3053, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Cnr Grattan St & Flemington Rd, Parkville, Victoria 3052, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Cnr Grattan St & Flemington Rd, Parkville, Victoria 3052, Australia; Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - Marion Saville
- VCS Pathology, VCS Foundation, 265 Faraday Street, Carlton South, Victoria 3053, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria 3010, Australia.
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Cespedes MS, Kang M, Kojic EM, Umbleja T, Godfrey C, Webster-Cyriaque JY, Masih R, Firnhaber C, Grinsztejn B, Saah A, Cu-Uvin S, Aberg JA. Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2018; 6:15-21. [PMID: 30118852 PMCID: PMC6121154 DOI: 10.1016/j.pvr.2018.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/25/2018] [Accepted: 08/06/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES People living with HIV have increased Human Papillomavirus (HPV) related lesions and malignancies. We describe HPV DNA recovered from the cervix and anal canal, explore the effect of vaccination on HPV detection, and examine the durability of vaccine titers in women living with HIV-1 who were vaccinated with the quadrivalent HPV vaccine. METHODS AIDS Clinical Trials Group A5240 was a prospective study of the quadrivalent HPV (qHPV) vaccine in 315 HIV-1 infected women in three CD4 strata (A: >350, B; 201-350, C: ≤200 cells/mm3). Vaccine was administered at entry, week 8 and week 24. Cervical and anal HPV DNA specimens were collected at baseline, weeks 28 and 52; serum for antibody testing was obtained at baseline, weeks 28 and 72. RESULTS Vaccine antibody titers decreased across all four HPV types at week 72 compared to week 28. Lower proportions of sustained seropositivity were observed in women with lower CD4 counts for all four vaccine types, with the lowest titers for HPV 18. Despite the decrease, the geometric mean titer levels were above the seroconversion cut-off levels for all types except HPV 18 in the lowest CD4 stratum. Of the 174 participants who had a negative baseline HPV 16 antibody and developed antibody response at week 28, 95%, 88%, and 86% retained seropositivity at week 72 in strata A, B, and C respectively. Lower antibody retention was observed in women with CD4 < 200 compared to CD4 > 350 (p = 0.016). Anal HPV detection was more prevalent compared to cervical detection at all visits. Among high risk types, type 52, 31, 16, 18 and 51 were the most common in the cervical compartment, while types 16, 35, 18, and 51 were the most prevalent in the anal canal at baseline (listed in the order of prevalence). Later detection of HPV not present at baseline was uncommon in either compartment. Serial recovery of HPV over time was more commonly observed in the anal canal. CONCLUSION The qHPV vaccine elicits durable titer response above the seroconversion cut-off levels in HIV-infected women. However, the titer levels were substantially lower by Week 72, most noticeably in type 18. HPV DNA was detected more frequently in the anal canal. Detection of non-vaccine high risk HPV suggests a role for the nonavalent vaccine.
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MESH Headings
- Adolescent
- Adult
- Anal Canal/virology
- Antibodies, Neutralizing/blood
- Antibodies, Viral/blood
- Cervix Uteri/virology
- DNA, Viral/analysis
- DNA, Viral/genetics
- Female
- HIV Infections/complications
- HIV Infections/immunology
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/administration & dosage
- Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18/immunology
- Humans
- Immunologic Memory
- Papillomavirus Infections/epidemiology
- Papillomavirus Infections/immunology
- Papillomavirus Infections/prevention & control
- Prevalence
- Prospective Studies
- Young Adult
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Affiliation(s)
- Michelle S Cespedes
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Minhee Kang
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Erna Milunka Kojic
- Division of Infectious Disease, Brown University, Providence, RI, United States
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Catherine Godfrey
- HIV Research Branch, TRP, DAIDS, NIAID, NIH, Bethesda, MD, United States
| | - Jennifer Y Webster-Cyriaque
- Departments of Microbiology, Immunology, and Dental Ecology, University of North Carolina, Chapel Hill, NC, United States
| | - Reena Masih
- ACTG Network Coordinating Center, Social & Scientific Systems, Silver Spring, MD, United States
| | - Cynthia Firnhaber
- Clinical HIV Research Unit, Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | - Beatriz Grinsztejn
- Infectious Diseases Department, Instituto de Pesquisa Clinica Evandro Chagas Fiocruz, Rio de Janeiro, Brazil
| | - Alfred Saah
- Merck & Co., Inc., Kenilworth, NJ, United States
| | - Susan Cu-Uvin
- Division of Infectious Disease, Brown University, Providence, RI, United States
| | - Judith A Aberg
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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86
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Feiring B, Laake I, Christiansen IK, Hansen M, Stålcrantz J, Ambur OH, Magnus P, Jonassen CM, Trogstad L. Substantial Decline in Prevalence of Vaccine-Type and Nonvaccine-Type Human Papillomavirus (HPV) in Vaccinated and Unvaccinated Girls 5 Years After Implementing HPV Vaccine in Norway. J Infect Dis 2018; 218:1900-1910. [PMID: 30010913 PMCID: PMC6217723 DOI: 10.1093/infdis/jiy432] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/12/2018] [Indexed: 12/12/2022] Open
Abstract
Background In 2009, quadrivalent human papillomavirus (HPV) vaccine was introduced in a school-based single-cohort program targeting 12-year-old girls in Norway. We estimated the impact of the Norwegian HPV immunization program. Methods Three birth cohorts of 17-year-old girls, 2 nonvaccine-eligible cohorts (born 1994 or 1996) and 1 vaccine-eligible cohort (born 1997) were invited to deliver urine samples. The samples were analyzed for 37 HPV genotypes. HPV prevalence was compared between birth cohorts and between vaccinated and unvaccinated girls within and across birth cohorts after linkage to the Norwegian Immunisation Registry. Results In total, 17749 urine samples were analyzed. A 42% (95% confidence interval [CI], 37%-47%) reduction in any HPV type and 81% (95% CI, 76%-85%) reduction in vaccine types (HPV-6/11/16/18) were observed in the vaccine-eligible cohort compared to the 1994 cohort. Vaccine types were reduced by 54% (95% CI, 39%-66%) and 90% (95% CI, 86%-92%) in unvaccinated and vaccinated girls, respectively, from the 1997 cohort, compared with unvaccinated girls born in 1994. A significant reduction was also observed for several nonvaccine types. Vaccine-type prevalence was reduced by 77% (95% CI, 65%-85%) in vaccinated compared with unvaccinated girls from the 1997 cohort. Conclusions In this largely HPV-naive population, we observed a substantial reduction in vaccine and nonvaccine types in vaccinated and unvaccinated girls following introduction of HPV vaccination.
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Affiliation(s)
- Berit Feiring
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo
| | - Ida Laake
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo
| | | | - Mona Hansen
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog
| | - Jeanette Stålcrantz
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo
| | - Ole Herman Ambur
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog
- Department of Natural Sciences and Health, Oslo Metropolitan University, Oslo
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo
| | | | - Lill Trogstad
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo
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87
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Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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88
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Guevara AM, Suarez E, Victoria A, Ngan HY, Hirschberg AL, Fedrizzi E, Bautista O, Shields C, Joshi A, Luxembourg A. Maternal transfer of anti HPV 6 and 11 antibodies upon immunization with the 9-valent HPV vaccine. Hum Vaccin Immunother 2018; 15:141-145. [PMID: 30261146 DOI: 10.1080/21645515.2018.1514227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND This exploratory analysis was conducted to characterize the level of HPV types 6/11 antibodies in peripartum maternal blood and in cord blood of infants born to women who received 9-valent HPV (9vHPV) vaccine or quadrivalent HPV (qHPV) vaccine in a pivotal efficacy study (V503-001, NCT 00543543). METHODS A total of 21 mother-infant pairs had evaluable HPV 6/11 results available for analysis. HPV6/11 antibodies were assessed using competitive Luminex immunoassay. The distribution of the ratios of infant to mother anti-HPV antibodies (i.e., infant-anti-HPV/mother- anti-HPV) was summarized. RESULTS All mothers and infants were seropositive to HPV 6 and HPV 11. Anti-HPV 6/11 geometric mean titers (GMTs) in peripartum maternal blood and in cord blood of infant born to study participants were highly correlated. A 100% of infants born to seropositive mothers were also seropositive. The GMT ratios of peripartum maternal blood vs. those in cord blood were HPV 6: 1.23 [0.43, 3.49] and HPV 11: 1.29 [0.54, 3.07] in the 9vHPV vaccine group and HPV 6: 1.33 [0.41, 4.29] and HPV 11: 1.19 [0.45, 3.13] in the qHPV vaccine group, respectively. CONCLUSIONS These results indicate that antibodies induced by the 9vHPV vaccine cross the placenta, which could potentially be beneficial against HPV6/11 infection and related disease such as recurrent respiratory papillomatosis.
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Affiliation(s)
- Ana Maria Guevara
- a Research Unit , Pablo Tobon Uribe Hospital, Medellin , Antioquia , Colombia
| | - Eugenio Suarez
- b Gynecological Oncology Division , Hospital Clinico San Borja Arriaran Universidad de Chile Campus Centro , Santiago , Chile
| | - Alejandro Victoria
- c Department of Obstetrics and Gynecology , Fundacion Valle del Lili , Cali , Colombia
| | - Hextan Ys Ngan
- d Department of Obstetrics & Gynaecology , The University of Hong Kong , Hong Kong , China
| | - Angelica Lindén Hirschberg
- e Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine , Karolinska University Hospital , Stockholm , Sweden
| | - Edison Fedrizzi
- f Department of Gynecology and Obstetrics , University of Santa Catarina , Florianópolis , Brazil
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90
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Jeannot E, Viviano M, de Pree C, Amadane M, Kabengele E, Vassilakos P, Petignat P. Prevalence of Vaccine Type Infections in Vaccinated and Non-Vaccinated Young Women: HPV-IMPACT, a Self-Sampling Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071447. [PMID: 29987255 PMCID: PMC6069376 DOI: 10.3390/ijerph15071447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 12/15/2022]
Abstract
Background: The human papillomavirus (HPV) vaccination program for young girls aged 11⁻26 years was introduced in Switzerland in 2008. The objective of this study was to evaluate the prevalence of high- and low-risk HPV in a population of undergraduate students using self-sampling for monitoring the HPV vaccination program's effect. METHODS Undergraduate women aged between 18⁻31 years, attending the Medical School and University of Applied Sciences in Geneva, were invited to participate in the study. Included women were asked to perform vaginal self-sampling for HPV testing using a dry cotton swab. RESULTS A total of 409 students participated in the study-aged 18⁻31 years-of which 69% of the participants were vaccinated with Gardasil HPV vaccine and 31% did not received the vaccine. About HPV prevalence, 7.2% of unvaccinated women were HPV 16 or 18 positive, while 1.1% of vaccinated women were infected by HPV 16 or 18 (p < 0.01). Prevalence of HPV 6 and 11 was 8.3% in non-vaccinated women versus 2.1% in vaccinated women (p < 0.02). We observed no cross-protection for the other HPV genotypes of a low- and high-risk strain. CONCLUSIONS Prevalence of HPV 6/11/16/18 was lower in vaccinated women versus unvaccinated women. Continued assessment of HPV vaccine effectiveness in real population is needed.
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Affiliation(s)
- Emilien Jeannot
- Institute of Global Health-Faculty of Medicine, Chemin de Mines 9, 1202 Geneva, Switzerland.
- Community Psychiatric Service, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.
| | - Manuella Viviano
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.
| | - Charlotte de Pree
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
| | - Mona Amadane
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland.
| | - Emmanuel Kabengele
- Institute of Global Health-Faculty of Medicine, Chemin de Mines 9, 1202 Geneva, Switzerland.
| | - Pierre Vassilakos
- Geneva Foundation for Medical Education and Research, Route de Ferney 150, 1211 Geneva 2, Switzerland.
| | - Patrick Petignat
- Gynecology Division, Department of Obstetrics and Gynecology, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, Switzerland.
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91
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St Laurent J, Luckett R, Feldman S. HPV vaccination and the effects on rates of HPV-related cancers. Curr Probl Cancer 2018; 42:493-506. [PMID: 30041818 DOI: 10.1016/j.currproblcancer.2018.06.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/05/2018] [Indexed: 02/07/2023]
Abstract
Globally, human papillomavirus (HPV) infection is one of the most common sexually transmitted infection. HPV is linked to at least five malignancies including vulvar, vaginal, anal penile, oropharyngeal, and cervical cancer. Three HPV vaccines are currently available: bivalent (HPV 16,18), quadrivalent (HPV 6,11,16,18), and nonavalent (6,11,16,18,31,33,45,52,58) targeting between 2 and 7 oncogenic HPV serotypes. This review highlights the currently epidemiologic burden of HPV-related cancers, efficacy of current HPV vaccines, and speculates about the benefits of widespread HPV vaccination. At present, all three vaccines are effective in reducing cervical disease and anogenital dysplasia in industry sponsored clinical trials and in limited study of clinical effectiveness. Models predict elimination of HPV infection with global vaccination rates of 80% and benefits in reducing malignancy at 20% global coverage. Large population-based clinical efficacy studies of these vaccines will be necessary to assess the true impact of vaccination. HPV vaccines provide a promising primary approach to preventing malignancy and barriers to vaccine access must be addressed to meet vaccination goals.
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Affiliation(s)
- Jessica St Laurent
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Rebecca Luckett
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sarah Feldman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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92
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Decline in prevalence of human papillomavirus infection following vaccination among Australian Indigenous women, a population at higher risk of cervical cancer: The VIP-I study. Vaccine 2018; 36:4311-4316. [PMID: 29880245 DOI: 10.1016/j.vaccine.2018.05.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/08/2018] [Accepted: 05/25/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cervical cancer occurrence and mortality are strongly correlated with socioeconomic disadvantage, largely due to unequal access to screening and treatment. Universal human papillomavirus (HPV) vaccination provides the opportunity to greatly reduce this global health disparity. Australian Indigenous women have substantially higher rates of cervical cancer than non-Indigenous women, primarily due to under-screening. We investigated HPV infection rates in Indigenous women 7 years after implementation of the national HPV vaccination program. METHODS We used a repeat cross-sectional design, with the baseline being provided by an HPV prevalence survey among Indigenous women attending clinics for cervical cytology screening, prior to the start of the vaccination program in 2007. We returned to clinics in four locations during 2014-15, and invited women aged 18-26 years attending for screening to provide a cervical specimen for HPV testing, as well as to complete a short questionnaire and consent to allow access of their records in the National HPV Vaccination Program Register. We used well-established laboratory methods to test specimens for specific HPV genotypes. RESULTS A total of 142 women were recruited at participating sites and compared to 155 who had been recruited at the same locations in the 2007 pre-vaccine survey. The two groups were identical in regard to age, with the more recent group having a higher proportion of hormonal contraception users, and a lower proportion of smokers. The proportion found to have any HPV type fell from 58 to 36% with the decline being entirely due to reductions in vaccine types, which fell by 94% from 24 to 1.4%. CONCLUSION Australia's national HPV vaccination program appears to be successfully protecting a very high proportion of Indigenous women against vaccine targeted HPV types, who have in the past been at elevated risk of cervical cancer.
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93
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Bretagne CH, Jooste V, Guenat D, Riethmuller D, Bouvier AM, Bedgedjian I, Prétet JL, Valmary-Degano S, Mougin C. Prevalence and distribution of HPV genotypes and cervical-associated lesions in sexually active young French women following HPV vaccine. J Gynecol Obstet Hum Reprod 2018; 47:525-531. [PMID: 29807205 DOI: 10.1016/j.jogoh.2018.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the availability of safe and effective HPV vaccines in France, more than 80% of girls remain unvaccinated. SETTING A regional university hospital referral center in France. OBJECTIVE To estimate the overall prevalence and distribution of HPV in vaccinated, sexually active young French women who were screened for cervical cancer by cytology and HPV testing. METHODS High-risk HPV (HR-HPV) prevalence, genotype-specific prevalence and extent of multiple infections were assessed in 125 cervical samples from females with available vaccine data using hc2 assay and INNO-LiPA assay. HPV status was analyzed in accordance with cytological data. RESULTS In our series, mean age was 23 years, overall prevalence of HR-HPV was 52% and was correlated with the lesion grade. The diversity of HPV genotypes was broad. Single HR-HPV infections were identified in 11%, 21% and 47% of women with NILM, ASC-US/-H and LSIL respectively. Multiple infections with HR-HPV were detected in 28% of the specimens. Only 24.5% of women with NILM presented infections with 2 genotypes or more, vs 28% of women with ASC-US/-H and 35% of women with LSIL. The overall prevalence of genotypes covered by the quadrivalent vaccine was low (5.9%); with 4.2%, 0%, 0.8% and 0.8% for HPV 16, HPV 18, HPV 6 and HPV 11 respectively. CONCLUSION Among HPV-vaccinated young women, HR-HPV are detected at a high rate, and an association with the grade of cytological abnormalities was observed. However, HPV 16 and 18, both targeted by the vaccines, are remarkably rare among young French women since program implementation.
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Affiliation(s)
- C H Bretagne
- Service d'Anatomie et cytologie pathologiques, CHU Besançon, Bd Fleming, 25000 Besançon, France.
| | - V Jooste
- Registre Bourguignon des Cancers Digestifs, Hôpital Universitaire Dijon-Bourgogne, 21000 Dijon, France; INSERM, U1231, EPICAD Team, Université Bourgogne-Franche-Comté, 21000 Dijon, France.
| | - D Guenat
- EA 3181, UFR SMP, Université Bourgogne Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, rue Ambroise Paré, 25000 Besançon, France; Centre National de Référence Papillomavirus, CHU Besançon, Bd Fleming, 25000 Besançon, France.
| | - D Riethmuller
- EA 3181, UFR SMP, Université Bourgogne Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, rue Ambroise Paré, 25000 Besançon, France; Service de gynécologie obstétrique, CHU Besançon, Bd Fleming, 25000 Besançon, France.
| | - A M Bouvier
- Registre Bourguignon des Cancers Digestifs, Hôpital Universitaire Dijon-Bourgogne, 21000 Dijon, France; INSERM, U1231, EPICAD Team, Université Bourgogne-Franche-Comté, 21000 Dijon, France.
| | - I Bedgedjian
- Service d'Anatomie et cytologie pathologiques, CHU Besançon, Bd Fleming, 25000 Besançon, France.
| | - J L Prétet
- EA 3181, UFR SMP, Université Bourgogne Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, rue Ambroise Paré, 25000 Besançon, France; Centre National de Référence Papillomavirus, CHU Besançon, Bd Fleming, 25000 Besançon, France.
| | - S Valmary-Degano
- Service d'Anatomie et cytologie pathologiques, CHU Besançon, Bd Fleming, 25000 Besançon, France; EA 3181, UFR SMP, Université Bourgogne Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, rue Ambroise Paré, 25000 Besançon, France.
| | - C Mougin
- EA 3181, UFR SMP, Université Bourgogne Franche-Comté, LabEx LipSTIC ANR-11-LABX-0021, rue Ambroise Paré, 25000 Besançon, France; Centre National de Référence Papillomavirus, CHU Besançon, Bd Fleming, 25000 Besançon, France.
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Final analysis of a study assessing genital human papillomavirus genoprevalence in young Australian women, following eight years of a national vaccination program. Vaccine 2018; 36:3221-3230. [PMID: 29724506 DOI: 10.1016/j.vaccine.2018.04.080] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The VACCINE [Vaccine Against Cervical Cancer Impact and Effectiveness] study evaluated the prevalence of quadrivalent vaccine-targeted human papillomavirus (HPV) genotypes (HPV 6, 11, 16, 18) amongst young women of vaccine-eligible age. METHODS Between October 2011 - June 2015, women aged 18-25 years from Victoria, Australia, were recruited through targeted advertising on the social networking website Facebook. Participants completed an online questionnaire and provided a self-collected vaginal swab for HPV DNA detection and genotyping (Linear Array HPV genotyping assay). Self-reported HPV vaccination details were verified with the National HPV Vaccination Program Register (NHVPR). RESULTS Of 1223 who agreed to participate, 916 (74.9%) completed the survey and, for 1007 (82.3%) sexually-active participants, 744 (73.9%) returned the self-collected swab, of which 737 contained detectable DNA. 184/737 (25.0%) were positive for HPV. Vaccine-targeted HPV genotypes were detected in only 13 (1.7%) women: 11 HPV 16 (six vaccinated after sexual debut, five unvaccinated) and two HPV 6. Prevalence of any of HPV 31/33/45 collectively was 2.9%, varying significantly by vaccination status (fully 2.0%, unvaccinated 6.8%; p = 0.01). Vaccination rates among the sexually-active cohort were high, with 65.6%, 71.6% and 74.2% of participants having received three, at least two or at least one dose of vaccine, respectively. Of women self-reporting HPV vaccination, the NHVPR confirmed one or more doses were received in 90%. Strong associations were observed between vaccination status, age, language spoken at home and country of birth, as well as between HPV detection and the number of male sexual partners. CONCLUSION Surveillance five to eight years' post-initiation of a national HPV vaccination program demonstrated a consistent and very low prevalence of vaccine-related HPV genotypes and some evidence of cross protection against related types amongst vaccine-eligible women from Victoria, Australia.
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