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Changes in human papillomavirus genotypes associated with cervical intraepithelial neoplasia grade 2 lesions in a cohort of young women (2013-2016). PAPILLOMAVIRUS RESEARCH 2018; 6:77-82. [PMID: 30391363 PMCID: PMC6260284 DOI: 10.1016/j.pvr.2018.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/06/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
Abstract
In 2008, a quadrivalent human papillomavirus (HPV) vaccine (genotypes 6, 11, 16, 18) became available in New Zealand. This study investigated whether the proportion of cervical intraepithelial neoplasia grade 2 (CIN2) lesions associated with HPV genotypes 16 and 18 changed over time in young women recruited to a prospective CIN2 observational management trial (PRINCess) between 2013 and 2016. Partial HPV genotyping (16, 18, or other high risk HPV) was undertaken on n = 392 women under 25 years (mean age 21.8, range 17–24) with biopsy-diagnosed CIN2. High risk HPV genotypes were detected in 96% of women with CIN2 lesions. Between 2013 and 2016, the proportion of women whose liquid-based cytology samples were HPV 16 or 18 positive decreased from 43% to 13%. HPV vaccination status was known for 78% of women. Between 2013 and 2016, the proportion of HPV 16/18 positivity did not significantly change in HPV-vaccinated women, but decreased from 66% to 17% in unvaccinated women. The reducing proportion of HPV 16/18-related CIN2 in our cohort of young New Zealand women may be attributable to the introduction of a national HPV vaccination program. The substantial decrease in HPV 16/18 positivity observed in unvaccinated women is likely to be due to a herd effect. 392 women under 25 years with CIN2 lesions were recruited between 2013 and 2016. HPV16/18 positivity decreased from 43% of women in 2013–13% in 2016. In vaccinated women, HPV16/18 positivity decreased from 17% in 2013 to 9% in 2016. In unvaccinated women, HPV16/18 positivity decreased from 66% in 2013 to 17% in 2016. Decreasing HPV16/18-related CIN2 may be due to HPV vaccination and herd effect.
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Lehtinen M, Luostarinen T, Vänskä S, Söderlund-Strand A, Eriksson T, Natunen K, Apter D, Baussano I, Harjula K, Hokkanen M, Kuortti M, Palmroth J, Petäjä T, Pukkala E, Rekonen S, Siitari-Mattila M, Surcel HM, Tuomivaara L, Paavonen J, Nieminen P, Dillner J, Dubin G, Garnett G. Gender-neutral vaccination provides improved control of human papillomavirus types 18/31/33/35 through herd immunity: Results of a community randomized trial (III). Int J Cancer 2018; 143:2299-2310. [PMID: 29845626 DOI: 10.1002/ijc.31618] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 01/05/2023]
Abstract
With optimal strategy, human papillomavirus (HPV) vaccines have the potential to control HPV. We have assessed vaccine efficacy (VE), herd effect (HE) of HPV vaccination and overall protective effectiveness (PE) against high-risk HPV infections by HPV type and vaccination strategy in a community-randomized trial using the bivalent HPV16/18 vaccine. We randomized 33 communities to gender-neutral HPV vaccination (Arm A), HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (Arm B) and gender-neutral HBV vaccination (Arm C). Entire 1992-1995 male (40,852) and female (39,420) birth cohorts were invited, and 11,662 males and 20,513 females vaccinated with 20-30% and 45% coverage in 2007-2010. During 2010-2014, 11,396 cervicovaginal samples were collected from 13,545 18.5-year-old attendees. HPV typing was performed by a high-throughput PCR. VE was calculated for HPV vaccinated women and HE for non-HPV-vaccinated women, using the HBV vaccinated, for HE all non-HPV vaccinated, Arm C women as controls. PE was calculated as coverage rate-weighted mean of VE + HE. HPV16/18/45 and 31/33/35 VEs varied between 86-94% and 30-66%, respectively. Only the gender-neutral vaccination provided significant HEs against HPV18 (61%) and HPV31 (72%) in the 1995 birth cohort-increased HEs against HPV33 (39%) and HPV35 (42%) were also observed. Due to the increased HEs, PEs for HPV16/18/45 and HPV31/33/35 were comparable in the gender-neutral arm 1995 birth cohort. High vaccine efficacy against HPV16/18/45 and, gender-neutral vaccination-enforced, herd effect against HPV18/31/33/35 by the bivalent vaccine rapidly provides comparable overall protective effectiveness against six oncogenic HPV types: 16/18/31/33/35/45.
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Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Tapio Luostarinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Simopekka Vänskä
- Helsinki and Oulu, Institute for Health and Welfare, Helsinki, Finland
| | | | - Tiina Eriksson
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Kari Natunen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Iacopo Baussano
- Department of Infections and Cancer, International Agency for Research on Cancer, Lyon, France
| | - Katja Harjula
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Mari Hokkanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Marjo Kuortti
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Johanna Palmroth
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Tiina Petäjä
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Eero Pukkala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Sirpa Rekonen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Heljä-Marja Surcel
- Department of Clinical Microbiology, Skåne University hospital, Lund, Sweden
| | - Leena Tuomivaara
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Gary Dubin
- Takeda Pharmaceuticals International, Zurich, Switzerland
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Lin CC, Hsieh MC, Hung HC, Tsao SM, Chen SC, Yang HJ, Lee YT. Human papillomavirus prevalence and behavioral risk factors among HIV-infected and HIV-uninfected men who have sex with men in Taiwan. Medicine (Baltimore) 2018; 97:e13201. [PMID: 30407359 PMCID: PMC6250439 DOI: 10.1097/md.0000000000013201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) infection is associated with cancer and can be prevented through vaccination. Few studies from Taiwan have reported on HPV infection among human immunodeficiency virus (HIV)-infected subjects. The aim of this study was to examine the prevalence of HPV infection among men who have sex with men (MSM) with and without HIV infection in Taiwan, and explore the behavioral risk factors thereof.We conducted a cross-sectional study in Taiwan during 2013 to 2016 to collect data on MSM aged 20 years or older. We used a questionnaire in a face-to-face interview, and subsequently collected oral, anal, and genital specimens from HIV-infected and HIV-uninfected subjects. Multivariate analysis was performed to predict factors associated with high-risk HPV (HR-HPV) positivity.Overall, 279 subjects, including 166 (59.5%) HIV-uninfected and 113 (40.5%) HIV-infected men were enrolled. Compared to HPV-negative subjects, HPV-positive subjects had significantly higher rates of receptive anal sex (91.3% vs 75.6%), substance use (22.6% vs 11%), history of sexually transmitted infections (75.7% vs 38.4%), anogenital or oral warts (39.1% vs 6.72%), syphilis (32.2% vs 11.6%), and HIV infection (69.6% vs 20.1%). We detected 489 HPV deoxyribonucleic acid (DNA) types (through 379 viable specimens), of which 43.6%, 5.7%, 56.4%, and 10.4% were HR-HPV type, HPV type 16, low-risk HPV types, and HPV type 6, respectively. In multivariate analysis, HIV-infected subjects had a significantly higher prevalence of HR-HPV infection (adjusted odds ratio, 5.80; 95% confidence interval, 2.57-13.11), compared to HIV-uninfected subjects.These results suggest that the prevalence of HPV infection was high among HIV-infected MSM. Additionally, anal HPV infection was observed to be common among both HIV-infected and HIV-uninfected MSM in Taiwan. The prevalence of oral and genital HPV infection, HR-HPV DNA types, and multiple HPV types was higher in HIV-infected subjects than in HIV-uninfected subjects. As only 35% of subjects practiced safe sex, we recommend routine HPV vaccination with 4-valent HPV or 9-valent HPV vaccines for both MSM, and HIV-infected subjects.
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Affiliation(s)
- Chia-Chun Lin
- Division of Infectious Diseases, Department of Internal Medicine
- Department of Public Health, College of Health Care and Management
| | - Ming-Chang Hsieh
- Department of Medical Laboratory and Biotechnology, College of Medical Sciences and Technology
- Department of Clinical Laboratory, Chung Shan Medical University Hospital
| | - Hung-Chang Hung
- Division of Gastroenterology, Department of Internal Medicine, Nantou Hospital, Ministry of Health and Welfare, Nantou
- Department of Healthcare Administration, Central Taiwan University of Science and Technology
| | - Shih-Ming Tsao
- Division of Infectious Diseases, Department of Internal Medicine
- School of Medicine, College of Medicine
- Institute of Biochemistry, Microbiology and Immunology
| | - Shiuan-Chih Chen
- School of Medicine, College of Medicine
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Hao-Jan Yang
- Department of Public Health, College of Health Care and Management
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Yuan-Ti Lee
- Division of Infectious Diseases, Department of Internal Medicine
- School of Medicine, College of Medicine
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Thamsborg LH, Napolitano G, Larsen LG, Lynge E. Impact of HPV vaccination on outcome of cervical cytology screening in Denmark-A register-based cohort study. Int J Cancer 2018; 143:1662-1670. [PMID: 29707775 PMCID: PMC6175001 DOI: 10.1002/ijc.31568] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/04/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Abstract
4vHPV vaccination has been tested in randomized controlled trials under almost ideal conditions, and studies of real-life use have compared outcome between vaccinated and unvaccinated women from the same birth cohort and mostly before screening age. Here we present the first-to our knowledge-evaluation of the impact of the 4vHPV vaccination in real life without selection bias in the reported data. The study has been carried out by comparing the results after first cervical screening between an HPV-vaccinated and an unvaccinated birth cohort, consisting of women born in Denmark in 1993 and 1983, respectively. Cytology data covering an 8-year period, from the age of 15 (age of HPV-vaccination) to age 23 (age of invitation to first cervical screening), were retrieved from the Danish National Pathology Register. Abnormal cytology, defined as atypical squamous cell of undetermined significance and worse (ASCUS+) was detected in 9.4% of women born in 1993 as compared with 9.0% of women born in 1983; RR = 1.04 (95% CI 0.96-1.12), p = .29. Detection of high-grade squamous intraepithelial lesion (HSIL) was statistically significantly lower in the 1993 than in the 1983 cohort, RR = 0.6 (95% CI 0.5-0.7), p < .0001, while the opposite pattern was seen for ASCUS RR = 1.4 (95% CI 1.2-1.6), p < .0001. The decrease in HSIL means that more women can be spared referral for colposcopy and biopsy. The increase of ASCUS could be explained by transition from conventional to liquid-based cytology, but this observation requires further monitoring.
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Affiliation(s)
| | - George Napolitano
- Department of Public HealthUniversity of CopenhagenCopenhagen1014Denmark
| | - Lise Grupe Larsen
- Department of PathologyZealand University HospitalRoskilde4000Denmark
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenEjegodvej 63DK‐4800Denmark
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Hirth J. Disparities in HPV vaccination rates and HPV prevalence in the United States: a review of the literature. Hum Vaccin Immunother 2018; 15:146-155. [PMID: 30148974 DOI: 10.1080/21645515.2018.1512453] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Human papillomavirus (HPV) is a common sexually transmitted infection which is the cause of several cancers, including cervical cancer, and genital warts. Although cervical cancer can be prevented through screening, this cancer persists in the US. More recently, HPV vaccination has the potential to decrease the burden of HPV-related disease among young HPV-unexposed adolescents. Several initiatives aimed to encourage HPV vaccination have been adopted. Unfortunately, uptake of the HPV vaccine remains modest, despite evidence that vaccine-type HPV prevalence is decreasing as a result of HPV vaccination. Further, geographic disparities in vaccination uptake across different US regions and by race/ethnicity may contribute to continuing disparities in HPV-related cancers. More data are needed to evaluate impact of HPV vaccination on HPV prevalence in smaller geographic areas. Further, more information is needed on the impact of individual vaccination programs and policy on population level vaccination and HPV prevalence.
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Affiliation(s)
- Jacqueline Hirth
- a Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology , University of Texas Medical Branch , Galveston, TX , USA
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56
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Cappelli MG, Fortunato F, Tafuri S, Boccalini S, Bonanni P, Prato R, Martinelli D. Cervical cancer prevention: An Italian scenario between organised screening and human papillomaviruses vaccination. Eur J Cancer Care (Engl) 2018; 27:e12905. [PMID: 30178893 PMCID: PMC6175343 DOI: 10.1111/ecc.12905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 01/15/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022]
Abstract
We aimed to assess the cervical cancer burden and performance of screening programme over the last decade in Apulia, Italy. Data from Hospital Discharge, Causes of Death and of Outpatient Services registries were analysed to estimate the disease burden, and data collected by the screening information system were used to evaluate the performance of the programme. We computed annual hospitalisation, incidence and mortality rates and number of outpatient services prescriptions for the follow-up of preneoplastic/neoplastic lesions. Indicators as proposed by the National Centre for Screening Monitoring were computed to describe the screening performance. Hospitalisation rates declined from 47 in 2001 to 28 per 100,000 in 2014, incidence from 10.3 in 2004 to 6.0 per 100,000 in 2014 and mortality from 1.4 in 2001 to 1.0 per 100,000 in 2010. Prescriptions increased from 3,333 in 2006 to 4,968 in 2010, then decreased to 3,634/year in 2012-2014. Actual extension of screening increased from 10.8% in 2007 to 62% in 2014; compliance with the invitation was 32%/year. In the last decade, we observed a reduction in the cervical cancer burden as early effect of screening implementation.
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Affiliation(s)
- Maria G Cappelli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesca Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Paolo Bonanni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Martinelli
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Lehtinen M. Which human papillomavirus vaccine and vaccination strategy for national programs? Acta Obstet Gynecol Scand 2018; 97:1049-1050. [DOI: 10.1111/aogs.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
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58
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Menon S, Rossi R, Kariisa M, Callens S. Determining the HPV vaccine schedule for a HIV-infected population in sub Saharan Africa, a commentary. Virol J 2018; 15:129. [PMID: 30115083 PMCID: PMC6097212 DOI: 10.1186/s12985-018-1039-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/08/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Epidemiological studies have established human papillomavirus (HPV) infection as the central cause of invasive cervical cancer (ICC) and its precursor lesions. HIV is associated with a higher prevalence and persistence of a broader range of high-risk HPV genotypes, which in turn results in a higher risk of cervical disease. Recent WHO HPV vaccination schedule recommendations, along with the roll out of HAART at an earlier CD4 count within the female HIV-infected population, may have programmatic implications for sub Saharan Africa. This communication identifies research areas, which will need to be addressed for determining a HPV vaccine schedule for this population in sub Saharan Africa. A review of WHO latest recommendations and the evidence concerning one-dose HPV vaccine schedules was undertaken. CONCLUSION For females ≥15 years at the time of first dose and immunocompromised and/or HIV-infected, a 3-dose schedule (0, 1-2, 6 months) is recommended for all three vaccines. There is some evidence that there is similar protection against HPV 16 and 18 infection from a single vaccination than from two or three doses, however there is no cross protection conferred to other genotypes. There is a need for periodic prevalence studies to determine the vaccination coverage of bivalent, quadrivalent and nonavalent vaccine targeted oncogenic HPV genotypes in women with CIN 3 or ICC at national level. In light of the increasing number of sub Saharan HIV-infected girls initiating HAART at a CD4 count above 350 mm3, there are a number of clinical, virological and public health research gaps to address before a tailored vaccine schedule can be established for this population.
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Affiliation(s)
- Sonia Menon
- International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium.
- International Committee of Red Cross, Geneva, Switzerland.
| | - Rodolfo Rossi
- International Committee of Red Cross, Geneva, Switzerland
| | | | - Steven Callens
- International Centre for Reproductive Health (ICRH), Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium
- Department of Internal Medicine & Infectious diseases, University Hospital, Ghent, Belgium
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Cuschieri K, Ronco G, Lorincz A, Smith L, Ogilvie G, Mirabello L, Carozzi F, Cubie H, Wentzensen N, Snijders P, Arbyn M, Monsonego J, Franceschi S. Eurogin roadmap 2017: Triage strategies for the management of HPV-positive women in cervical screening programs. Int J Cancer 2018; 143:735-745. [PMID: 29341110 DOI: 10.1002/ijc.31261] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/20/2017] [Accepted: 01/03/2018] [Indexed: 01/04/2023]
Abstract
Cervical cancer screening will rely, increasingly, on HPV testing as a primary screen. The requirement for triage tests which can delineate clinically significant infection is thus prescient. In this EUROGIN 2017 roadmap, justification behind the most evidenced triages is outlined, as are challenges for implementation. Cytology is the triage with the most follow-up data; the existence of an HR-HPV-positive, cytology-negative group presents a challenge and retesting intervals for this group (and choice of retest) require careful consideration. Furthermore, cytology relies on subjective skills and while adjunctive dual-staining with p16/Ki67 can mitigate inter-operator/-site disparities, clinician-taken samples are required. Comparatively, genotyping and methylation markers are objective and are applicable to self-taken samples, offering logistical advantages including in low and middle income settings. However, genotyping may have diminishing returns in immunised populations and type(s) included must balance absolute risk for disease to avoid low specificity. While viral and cellular methylation markers show promise, more prospective data are needed in addition to refinements in automation. Looking forward, systems that detect multiple targets concurrently such as next generation sequencing platforms will inform the development of triage tools. Additionally, multistep triage strategies may be beneficial provided they do not create complex, unmanageable pathways. Inevitably, the balance of risk to cost(s) will be key in decision making, although defining an acceptable risk will likely differ between settings. Finally, given the significant changes to cervical screening and the variety of triage strategies, appropriate education of both health care providers and the public is essential.
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Affiliation(s)
- Kate Cuschieri
- Scottish HPV Reference Laboratory, Department of Laboratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, United Kingdom
| | - Guglielmo Ronco
- Centre for Cancer Prevention (CPO), AOU Città della Salute e della Scienza via Cavour 39, Torino, 10123, Italy
| | - Attila Lorincz
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom
| | - Laurie Smith
- University of British Columbia and BC Women's Hospital and Health Centre, 4500 Oak Street, Vancouver, British Columbia, V6H 3N1, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Lisa Mirabello
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Francesca Carozzi
- Cancer Prevention Regional Laboratory, ISPO, Cancer Prevention and Research Institute, Florence, Italy
| | - Heather Cubie
- Global Health Academy, University of Edinburgh, Teviot Quad, Edinburgh, EH8 9PG, United Kingdom
| | - Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Peter Snijders
- Department of Pathology, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Centre, Scientific Institute of Public Health, Brussels, Belgium
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Purriños-Hermida MJ, Santiago-Pérez MI, Treviño M, Dopazo R, Cañizares A, Bonacho I, Trigo M, Fernández ME, Cid A, Gómez D, Ordóñez P, Coira A, Armada MJ, Porto M, Perez S, Malvar-Pintos A. Direct, indirect and total effectiveness of bivalent HPV vaccine in women in Galicia, Spain. PLoS One 2018; 13:e0201653. [PMID: 30075010 PMCID: PMC6075752 DOI: 10.1371/journal.pone.0201653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/19/2018] [Indexed: 01/08/2023] Open
Abstract
Bivalent human papillomavirus (HPV) vaccine was incorporated into the childhood vaccination calendar in Galicia, Spain in 2008. The objectives of this study were to estimate direct, indirect and total effectiveness of HPV vaccine and to identify sexual habits changes in the post-vaccination period in Galicia, Spain.Endocervical scrapings of 745 women attending 7 Health Areas of the Galician Public Health Service were collected in the post-vaccination period, from 2014-2017. Two groups were studied: women born between 1989 and 1993 (n = 397) and women born in 1994 or later (n = 348). Twelve high-risk human papillomavirus (HR-HPV) genotypes were detected by Cobas® 4800 HPV test (Roche Diagnostics, Mannheim, Germany). The Linear Array® HPV Genotyping Test (Roche Diagnostics) was used for HR-HPV genotype detection other than HPV 16/18. Information about sexual habits was collected by a self-filled questionnaire. Post-vaccination data were compared to previously published pre-vaccination data obtained between 2008 and 2010 in Galicia from women of the same age (18-26 years old, n = 523). The Stata 14.2 software was employed for statistical analyses.Data from 392 unvaccinated and 353 vaccinated women were compared. For unvaccinated and vaccinated women, HPV 16/18 prevalence was 9.2% and 0.8%, respectively, and HPV 31/33/45 prevalence was 8.4% and 1.1%, respectively. Direct, indirect and total effectiveness of the HPV vaccine were (%, 95% CI): 94 (72-99), 30 (-11-56) and 95 (79-99), respectively, for HPV 16/18 and 83 (46-94), -10 (-88-33) and 84 (54-94), respectively, for HPV 31/33/45. The number of women with first intercourse before 17 years old and 3 or more sexual partners along life was higher in the post-vaccination period (p < 0.05). A positive impact of bivalent HPV vaccine was observed, both on direct and cross protection. Sexual habits could have changed in the post-vaccination period.
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Affiliation(s)
- M. Jesus Purriños-Hermida
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain
- * E-mail: (MJPH); (AMP)
| | - María Isolina Santiago-Pérez
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain
| | - Mercedes Treviño
- Microbiology Department, University Hospital of Santiago, Santiago de Compostela, Spain
| | - Rafaela Dopazo
- Gynecology Department, University Hospital of Santiago, Santiago de Compostela, Spain
| | - Angelina Cañizares
- Microbiology Department, University Hospital of A Coruña, A Coruña, Spain
| | - Isolina Bonacho
- Gynecology Department, University Hospital of A Coruña, A Coruña, Spain
| | - Matilde Trigo
- Microbiology Department, University Hospital of Pontevedra, Pontevedra, Spain
| | - M. Eva Fernández
- Gynecology Department, University Hospital of Pontevedra, Pontevedra, Spain
| | - Ana Cid
- Microbiology Department, University Hospital of Ourense, Ourense, Spain
| | - David Gómez
- Gynecology Department, University Hospital of Ourense, Ourense, Spain
| | - Patricia Ordóñez
- Microbiology Department, University Hospital of Ferrol, Ferrol, Spain
| | - Amparo Coira
- Microbiology Department, University Hospital of Lugo, Lugo, Spain
| | - M. J. Armada
- Fingoy Primary Care Department, Sanitary Area of Lugo, Lugo, Spain
| | - Magdalena Porto
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - Sonia Perez
- Microbiology Department, University Hospital of Vigo, Vigo, Spain
- Galicia Sur Health Research Institute, Vigo, Vigo, Spain
| | - Alberto Malvar-Pintos
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain
- * E-mail: (MJPH); (AMP)
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Wolff E, Elfström KM, Haugen Cange H, Larsson S, Englund H, Sparén P, Roth A. Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. Vaccine 2018; 36:5160-5165. [PMID: 30017146 DOI: 10.1016/j.vaccine.2018.07.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. METHODS We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. RESULTS A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. CONCLUSION Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.
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Affiliation(s)
- Ellen Wolff
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden.
| | - K Miriam Elfström
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden; Regional Cancer Centre of Stockholm-Gotland, Västgötagatan 2, Sweden
| | - Hedda Haugen Cange
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Dept. of Obstetrics and Gynecology, Sahlgrenska University Hospital, Östra, SE 416 85 Gothenburg, Sweden
| | - Sofie Larsson
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden
| | - Helene Englund
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden
| | - Pär Sparén
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden
| | - Adam Roth
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Institution for Translational Medicine, Lund University, J Waldenströms g 35, CRC, hus 92, plan 11, Malmö, Sweden
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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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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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Adjei Boakye E, Lew D, Muthukrishnan M, Tobo BB, Rohde RL, Varvares MA, Osazuwa-Peters N. Correlates of human papillomavirus (HPV) vaccination initiation and completion among 18-26 year olds in the United States. Hum Vaccin Immunother 2018; 14:2016-2024. [PMID: 29708826 DOI: 10.1080/21645515.2018.1467203] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To examine correlates of HPV vaccination uptake in a nationally representative sample of 18-26-year-old adults. METHODS Young adults aged 18-26 years were identified from the 2014 and 2015 National Health Interview Survey (n = 7588). Survey-weighted multivariable logistic regression models estimated sociodemographic factors associated with HPV vaccine initiation (≥1 dose) and completion (≥3 doses). RESULTS Approximately 27% of study participants had initiated the HPV vaccine and 16% had completed the HPV vaccine. Participants were less likely to initiate the vaccine if they were men [(adjusted odds ratio) 0.19; (95% confidence interval) 0.16-0.23], had a high school diploma (0.40; 0.31-0.52) or less (0.46; 0.32-0.64) vs. college graduates, and were born outside the United States (0.52; 0.40-0.69). But, participants were more likely to initiate the HPV vaccine if they visited the doctor's office 1-5 times (2.09; 1.56-2.81), or ≥ 6 times (1.86; 1.48-2.34) within the last 12 months vs. no visits. Odds of completing HPV vaccine uptake followed the same pattern as initiation. And after stratifying the study population by gender and foreign-born status, these variables remained statistically significant. CONCLUSIONS In our nationally representative study, only one out of six 18-26 year olds completed the required vaccine doses. Men, individuals with high school or less education, and those born outside the United States were less likely to initiate and complete the HPV vaccination. Our findings suggest that it may be useful to develop targeted interventions to promote HPV vaccination among those in the catch-up age range.
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Affiliation(s)
- Eric Adjei Boakye
- a Saint Louis University Center for Health Outcomes Research (SLUCOR), Saint Louis University , Saint Louis , MO , USA
| | - Daphne Lew
- b Department of Biostatistics , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA
| | - Meera Muthukrishnan
- c Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA
| | - Betelihem B Tobo
- c Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA
| | - Rebecca L Rohde
- d Saint Louis University School of Medicine , Saint Louis , MO , USA
| | - Mark A Varvares
- e Department of Otolaryngology , The Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , MA , USA
| | - Nosayaba Osazuwa-Peters
- c Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , Saint Louis , MO , USA.,f Department of Otolaryngology-Head and Neck Surgery , Saint Louis University , Saint Louis , MO , USA.,g Saint Louis University Cancer Center , Saint Louis , MO , USA
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Mallory ML, Lindesmith LC, Baric RS. Vaccination-induced herd immunity: Successes and challenges. J Allergy Clin Immunol 2018; 142:64-66. [PMID: 29803799 DOI: 10.1016/j.jaci.2018.05.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Michael L Mallory
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Lisa C Lindesmith
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Ralph S Baric
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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Smith C, Ding L, Gorbach PM, Franco EL, Kahn JA. Who's Not Protected in the Herd? Factors Associated with Vaccine-Type HPV in Unvaccinated Women. J Pediatr Adolesc Gynecol 2018; 31:89-93. [PMID: 28943220 PMCID: PMC5862729 DOI: 10.1016/j.jpag.2017.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Evidence suggests that vaccine-type human papillomavirus (HPV) prevalence may decrease in unvaccinated women after HPV vaccine introduction, indicating herd protection. The aim of this study was to determine factors associated with vaccine-type HPV (i.e. absence of herd protection) after vaccine introduction. DESIGN We conducted three cross-sectional studies from 2006-2014 (n = 1180): wave 1 (2006-2007), wave 2 (2009-2010), and wave 3 (2013-2014). SETTING Participants were recruited from a hospital-based teen health center and a community health department. PARTICIPANTS We recruited 13-26 year-old young women; those included in this analysis had not received an HPV vaccine. INTERVENTIONS AND MAIN OUTCOME MEASURES The outcome measure was infection with at least one vaccine-type HPV (HPV6, 11, 16, 18). RESULTS Multivariable logistic regression demonstrated that in wave 1 (before vaccine introduction), history of anal intercourse (OR = 1.8, 95% CI = 1.1-3.0), age 18-21 vs 13-17 years (OR = 2.1, CI = 1.2-3.6), and Black/multiracial vs White race (OR = 1.8, CI = 1.1-3.0) were associated with vaccine-type HPV in unvaccinated women. In wave 2, no variables were associated with HPV. In wave 3, sexually transmitted infection history (OR = 3.6, CI = 1.3-9.7) was associated with HPV. CONCLUSION We did not identify a consistent set of modifiable risk factors associated with vaccine-type HPV after vaccine introduction across the three study waves, underscoring the urgency of vaccination for primary HPV prevention and the limitations of relying on herd protection.
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Affiliation(s)
- C Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - L Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - P M Gorbach
- University of California, Los Angeles, Los Angeles, California
| | - E L Franco
- McGill University, Montreal, Quebec, Canada
| | - J A Kahn
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Abstract
The discovery of genotype 16 as the prototype oncogenic human papillomavirus (HPV) initiated a quarter century of laboratory and epidemiological studies that demonstrated their necessary, but not sufficient, aetiological role in cervical and several other anogenital and oropharyngeal cancers. Early virus-induced immune deviation can lead to persistent subclinical infection that brings the risk of progression to cancer. Effective secondary prevention of cervical cancer through cytological and/or HPV screening depends on regular and widespread use in the general population, but coverage is inadequate in low-resource settings. The discovery that the major capsid antigen L1 could self-assemble into empty virus-like particles (VLPs) that are both highly immunogenic and protective led to the licensure of several prophylactic VLP-based HPV vaccines for the prevention of cervical cancer. The implementation of vaccination programmes in adolescent females is underway in many countries, but their impact critically depends on the population coverage and is improved by herd immunity. This Review considers how our expanding knowledge of the virology and immunology of HPV infection can be exploited to improve vaccine technologies and delivery of such preventive strategies to maximize reductions in HPV-associated disease, including incorporation of an HPV vaccine covering oncogenic types within a standard multitarget paediatric vaccine.
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Affiliation(s)
| | - Peter L. Stern
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Wiley DJ, Mastro KA. An effective human papillomavirus vaccination policy will reduce infection- and malignancy-related morbidity and mortality. Nurs Outlook 2018; 66:319-324. [PMID: 29724449 DOI: 10.1016/j.outlook.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lehtinen M, Söderlund-Strand A, Vänskä S, Luostarinen T, Eriksson T, Natunen K, Apter D, Baussano I, Harjula K, Hokkanen M, Kuortti M, Palmroth J, Petäjä T, Pukkala E, Rekonen S, Siitari-Mattila M, Surcel HM, Tuomivaara L, Paavonen J, Dillner J, Dubin G, Garnett G. Impact of gender-neutral or girls-only vaccination against human papillomavirus-Results of a community-randomized clinical trial (I). Int J Cancer 2018; 142:949-958. [PMID: 29055031 DOI: 10.1002/ijc.31119] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/08/2017] [Accepted: 09/25/2017] [Indexed: 01/03/2023]
Abstract
Human papillomavirus (HPV) vaccine is efficacious but the real-life effectiveness of gender-neutral and girls-only vaccination strategies is unknown. We report a community-randomized trial on the protective effectiveness [(PE) = vaccine efficacy (VE) + herd effect (HE)] of the two strategies among females in virtually HPV vaccination naïve population. We randomized 33 Finnish communities into Arm A) gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (11 communities), Arm B) HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (11 communities) or Arm C) gender-neutral HBV vaccination (11 communities). All resident 39,420 females and 40,852 males born 1992-95 were invited in 2007-09. Virtually all (99%) 12- to 15-year-old participating males (11,662) and females (20,513) received three doses resulting in uniform 20-30% male and 50% female vaccination coverage by birth cohort. Four years later (2010-14) 11,396 cervicovaginal samples obtained from 18.5 year-old women were tested for HPV DNA, and prevalence of cervical HPV infections by trial arm and birth cohort was the main outcome measure. VEs against HPV16/18 varied between 89.2% and 95.2% across birth cohorts in arms A and B. The VEs against non-vaccine types consistent with cross-protection were highest in those born 1994-95 for HPV45 (VEA 82.8%; VEB 86.1%) and for HPV31 (VEA 77.6%, VEB 84.6%). The HEs in the non HPV-vaccinated were statistically significant in those born 1994-95 for HPV18 (HEA 51.0%; 95% CI 8.3-73.8, HEB 47.2%; 6.5-70.2) and for HPV31/33 in arm A (HEA 53.7%; 22.1-72.5). For HPV16 and 45 no significant herd effects were detected. PE estimates against HPV16/18 were similar by both strategies (PEA 58.1%; 45.1-69.4; PEB 55.7%; 42.9-66.6). PE estimates against HPV31/33 were higher by the gender-neutral vaccination (PEA 60.5%; 43.6-73.4; PEB 44.5%; 24.9-60.6). In conclusion, while gender-neutral strategy enhanced the effectiveness of HPV vaccination for cross-protected HPV types with low to moderate coverage, high coverage in males appears to be key to providing a substantial public health benefit also to unvaccinated females. Trial registration www.clinicaltrials.gov.com NCT000534638.
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Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | | | | | - Tapio Luostarinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Tiina Eriksson
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Kari Natunen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | - Iacopo Baussano
- Department of Infections and Cancer, International Agency for Research on Cancer, Lyon, France
| | - Katja Harjula
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mari Hokkanen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Marjo Kuortti
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Johanna Palmroth
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Tiina Petäjä
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Eero Pukkala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Sirpa Rekonen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | | | - Leena Tuomivaara
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Gary Dubin
- Takeda Pharmaceuticals International, Switzerland
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Mesher D, Soldan K, Lehtinen M, Beddows S, Brisson M, Brotherton JML, Chow EPF, Cummings T, Drolet M, Fairley CK, Garland SM, Kahn JA, Kavanagh K, Markowitz L, Pollock KG, Söderlund-Strand A, Sonnenberg P, Tabrizi SN, Tanton C, Unger E, Thomas SL. Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes. Emerg Infect Dis 2018; 22:1732-40. [PMID: 27648688 PMCID: PMC5038419 DOI: 10.3201/eid2210.160675] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20-24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important.
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Jacot-Guillarmod M, Pasquier J, Greub G, Bongiovanni M, Achtari C, Sahli R. Impact of HPV vaccination with Gardasil® in Switzerland. BMC Infect Dis 2017; 17:790. [PMID: 29273004 PMCID: PMC5741926 DOI: 10.1186/s12879-017-2867-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/28/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Gardasil®, a quadrivalent vaccine targeting low-risk (6, 11) and high-risk (16, 18) human papillomaviruses (HPV), has been offered to 11-14 year-old schoolgirls in Switzerland since 2008. To evaluate its success and its potential impact on cervical cancer screening, HPV genotypes were examined in 18-year-old girls five years later (sub-study 1) and in outpatients participating to cervical cancer screening before and after vaccine implementation (sub-study 2). METHODS For sub-study 1, 3726 females aged 18 in 2013 were invited to fill a questionnaire on personal demographics and HPV risk factors and to provide a self-collected cervicovaginal sample for HPV genotyping and Chlamydia trachomatis PCR. Personal data were evaluated by univariable and multivariable statistics. In sub-study 2, the proportion of the vaccine-type HPV among anogenital HPV was examined with archived genotyping data of 8039 outpatients participating to cervical cancer screening from 1999 till 2015. The yearly evolution of this proportion was evaluated by segmented logistic regression. RESULTS 690 (18.5%) women participated to sub-study 1 and 327 (8.8%) provided a self-collected sample. Prevalence of Chlamydia trachomatis (4.6%) and demographics confirmed that the subjects were representative of sexually-active Swiss young women. Vaccine (five-year coverage: 77.5%) was preferentially accepted by contraceptive-pill users (P = 0.001) and samples were mainly provided by sexually-active subjects (P < 0.001). The proportion (4%) of the vaccine-type HPV in this population was lower than in sub-study 2 outpatients (n = 849, <26 years old) in the pre-vaccine era (25.7%). The proportion of the high-risk vaccine-type HPV decreased significantly (59%, P = 0.0048) in the outpatients during the post-vaccine era, yet this decrease was restricted to those aged less than 26 years (n = 673, P < 0.0001). CONCLUSIONS The low proportion of vaccine-type HPV in 18-year-old females and its rapid decrease in young women participating to cervical cancer screening extend the success of HPV vaccination to Switzerland. Our data suggest that cervical cancer screening is now entering a stage of reduced proportion of HPV16 and/or 18 in samples reported positive by cytology. In view of the high likelihood of reduced clinical specificity of cytology, primary screening modalities involving HPV testing and cytology should now be re-evaluated in Switzerland.
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Affiliation(s)
- Martine Jacot-Guillarmod
- Service of Gynecology and Obstetrics, Lausanne University Hospital, Pierre-Decker 2, 1011, Lausanne, Switzerland
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine, Lausanne University Hospital and University of Lausanne, Corniche 10, 1010, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital, Bugnon 48, 1011, Lausanne, Switzerland
| | - Massimo Bongiovanni
- Institute of Pathology, Lausanne University Hospital, Bugnon 25, 1011, Lausanne, Switzerland
| | - Chahin Achtari
- Service of Gynecology and Obstetrics, Lausanne University Hospital, Pierre-Decker 2, 1011, Lausanne, Switzerland.
| | - Roland Sahli
- Institute of Microbiology, Lausanne University Hospital, Bugnon 48, 1011, Lausanne, Switzerland. .,WHO HPV Regional Reference Laboratory for Europe, Bugnon 48, 1011, Lausanne, Switzerland.
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Goggin P, Sauvageau C, Gilca V, Defay F, Lambert G, Mathieu-C S, Guenoun J, Comète E, Coutlée F. Low prevalence of vaccine-type HPV infections in young women following the implementation of a school-based and catch-up vaccination in Quebec, Canada. Hum Vaccin Immunother 2017; 14:118-123. [PMID: 29049007 DOI: 10.1080/21645515.2017.1385688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In Quebec, Canada, a school-based HPV vaccination for girls has been offered since 2008. The vaccine used in the program targets HPV16/18, responsible for ∼70% of cervical cancers and HPV6/11, responsible for the majority of anogenital warts. The objective of this study was to assess the prevalence of HPV in vaccinated and unvaccinated women. METHODS Women aged 17-29 years were eligible to participate. Participants' age, vaccination status and diverse risk factors were assessed by a computer-assisted questionnaire. Biological specimens were obtained by self-sampling. HPV genotyping was performed by Linear Array. RESULTS A total of 2,118 women were recruited. 2,042 completed the questionnaire and 1,937 provided a vaginal sample. Vaccination coverage varied from 83.5% in women aged 17-19 to 19.1% in those aged 23-29. The overall prevalence of HPV in sexually active women was 39.4% (95%CI: 37.0-41.7) and 56.7% of infected women had multiple type infections. The prevalence of vaccine HPV types varied by age and vaccination status except for women aged 23-29 for whom similar results were observed. Vaccine HPV types were detected in 0.3%, 1.4% and 10.5% of vaccinated women aged 17-19, 20-23, and 23-29 (p<0.05), respectively. HPV16 or HPV18 were detected in 10 women having received at least one dose of vaccine. Nine of these women were already sexually active at the time of vaccination. CONCLUSION Infections with HPV types included in the vaccine are rare in women aged less than 23 years and are virtually absent in those who received at least one dose of vaccine before sexual debut.
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Affiliation(s)
- P Goggin
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - C Sauvageau
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - V Gilca
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - F Defay
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - G Lambert
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - S Mathieu-C
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,c Département de Psychopédagogie et D'andragogi, Faculté des Sciences de L'éducation , Université de Montréal , Montréal , Québec , Canada
| | - J Guenoun
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - E Comète
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - F Coutlée
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada.,e Département de Microbiologie et Immunologie , Université de Montréal , Montréal , Québec , Canada
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Kavanagh K, Pollock KG, Cuschieri K, Palmer T, Cameron RL, Watt C, Bhatia R, Moore C, Cubie H, Cruickshank M, Robertson C. Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1293-1302. [DOI: 10.1016/s1473-3099(17)30468-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023]
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Ding L, Widdice LE, Kahn JA. Differences between vaccinated and unvaccinated women explain increase in non-vaccine-type human papillomavirus in unvaccinated women after vaccine introduction. Vaccine 2017; 35:7217-7221. [PMID: 29169890 DOI: 10.1016/j.vaccine.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/11/2017] [Accepted: 11/03/2017] [Indexed: 01/27/2023]
Abstract
The aim of this study was to determine whether an observed increase in non-vaccine-type human papillomavirus (HPV) in unvaccinated women during the first eight years after vaccine introduction may be explained by differences in demographics or sexual behaviors, instead of type replacement. We analyzed data from three cross-sectional surveillance studies of 13-26 year-old women (total N = 1180). For women recruited from a health department clinic, older age (OR = 1.4, 95% CI: 1.2-1.6) and consistent condom use with main partner in the past 3 months (OR = 11.6, 95% CI: 3.4-40) were associated with being unvaccinated. For women recruited from a teen health center African American race (OR = 0.2, 95% CI: 0.07-0.7) and having Medicaid health insurance (OR = 0.3, 95% CI: 0.1-0.7) were inversely associated with being unvaccinated. The observed increase in non-vaccine-type HPV prevalence in unvaccinated women may be explained by differences between unvaccinated and vaccinated women.
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Affiliation(s)
- Lili Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Lea E Widdice
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
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77
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Perez S, Iñarrea A, Pérez-Tanoira R, Gil M, López-Díez E, Valenzuela O, Porto M, Alberte-Lista L, Peteiro-Cancelo MA, Treinta A, Carballo R, Reboredo MC, Alvarez-Argüelles ME, Purriños MJ. Fraction of high-grade cervical intraepithelial lesions attributable to genotypes targeted by a nonavalent HPV vaccine in Galicia, Spain. Virol J 2017; 14:214. [PMID: 29110680 PMCID: PMC5674742 DOI: 10.1186/s12985-017-0879-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022] Open
Abstract
Background Human papillomavirus (HPV) bivalent and quadrivalent vaccines have been widely implemented in worldwide organized immunization programs. A nonavalent HPV vaccine is now available in several countries. The objective was to describe the fraction of squamous non-invasive high-grade cervical intraepithelial lesions attributable to genotypes targeted by bi-quadrivalent vaccines and by nonavalent vaccine according to age and diagnosis in women living in the city of Vigo (Galicia, Spain). Methods Cervical scrapings (2009–2014) of women with histological diagnosis of cervical intraepithelial neoplasia grade 2 (CIN2, n = 145) and grade 3-carcinoma in situ (CIN3-CIS, n = 244) were tested with Linear Array HPV Genotyping test (Roche diagnostics, Mannheim, Germany). Hierarchical estimation of the fraction attributable to HPV 16/18 or HPV 31/33/45/52/58 detected alone or in combination was calculated. Absolute additional fraction attributable to genotypes targeted by nonavalent vaccine compared to genotypes targeted by bi-quadrivalent vaccines was calculated as the increment of attributable cases with respect to all studied cases. Age group 1, 2 and 3 included women 18 to 34, 35–44 and ≥45 years old, respectively. EPIDAT 3.1 was used. Results Fraction attributable to genotypes targeted by bi-quadrivalent vaccines was 59% CIN2 vs. 69% CIN3-CIS (p < 0.001). It was 63/51/50% of CIN2 and 78/66/45% of CIN3-CIS in age group 1, 2, 3, respectively. Fraction attributable to genotypes targeted by nonavalent vaccine was 86% CIN2 and 86% CIN3-CIS. It was 87/91/75% of CIN2 and 90/86/76% of CIN3-CIS in age group 1, 2, 3, respectively. Fraction attributable to genotypes targeted by these vaccines tended to decrease as age increased (p-trend <0.05). Globally, absolute additional attributable fraction was 16%, 26% and 29% in age group 1, 2 and 3, respectively (p < 0.005). Conclusions Absolute additional fraction of CIN2 and CIN3-CIS attributable to genotypes targeted by nonavalent vaccine was observed in women of any age, especially in those over 35 years old.
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Affiliation(s)
- S Perez
- Microbiology Department, Institute of Biomedical Research of Vigo, University Hospital of Vigo, Vigo, Spain.
| | - A Iñarrea
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - R Pérez-Tanoira
- Internal Medicine Department, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - M Gil
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - E López-Díez
- Urology Department, University Hospital of Vigo, Vigo, Spain
| | - O Valenzuela
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - M Porto
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | - L Alberte-Lista
- Pathology Department, University Hospital of Vigo, Vigo, Spain
| | | | - A Treinta
- Microbiology Department, Institute of Biomedical Research of Vigo, University Hospital of Vigo, Vigo, Spain
| | - R Carballo
- Microbiology Department, Institute of Biomedical Research of Vigo, University Hospital of Vigo, Vigo, Spain
| | - M C Reboredo
- Gynecology Department, University Hospital of Vigo, Vigo, Spain
| | | | - M J Purriños
- Health and Epidemiology Department. Innovation and management of public health. Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, A Coruña, Spain
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Huang LM, Puthanakit T, Cheng-Hsun C, Ren-Bin T, Schwarz T, Pellegrino A, Esposito S, Frenette L, McNeil S, Durando P, Rheault P, Giaquinto C, Horn M, Petry KU, Peters K, Azhar T, Hillemanns P, De Simoni S, Friel D, Pemmaraju S, Hezareh M, Thomas F, Descamps D, Folschweiller N, Struyf F. Sustained Immunogenicity of 2-dose Human Papillomavirus 16/18 AS04-adjuvanted Vaccine Schedules in Girls Aged 9-14 Years: A Randomized Trial. J Infect Dis 2017; 215:1711-1719. [PMID: 28591778 PMCID: PMC5853959 DOI: 10.1093/infdis/jix154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/20/2017] [Indexed: 01/20/2023] Open
Abstract
Background. We previously reported the noninferiority 1 month after the last dose of 2-dose human papillomavirus 16/18 AS04-adjuvanted (AS04-HPV-16/18) vaccine schedules at months 0 and 6 (2D_M0,6) and months 0 and 12 (2D_M0,12) in girls aged 9–14 years compared with a 3-dose schedule at months 0, 1, and 6 (3D_M0,1,6) in women aged 15–25 years. Here, we report the results at study end (month 36 [M36]). Methods. Girls were randomized 1:1 and received 2 vaccine doses either 6 months (2D_M0,6) or 12 months apart (2D_M0,12); women received 3 doses at months 0, 1, and 6 (3D_M0,1,6). Endpoints included noninferiority of HPV-16/18 antibodies for 2D_M0,6 versus 3D_M0,1,6; 2D_M0,12 versus 3D_M0,1,6; and 2D_M0,12 versus 2D_M0,6; and assessment of neutralizing antibodies, T cells, B cells, and safety. Results. At M36, the 2D_M0,6 and 2D_M0,12 schedules remained noninferior to the 3D_M0,1,6 schedule in terms of seroconversion rates and 3D/2D geometric mean titers for anti-HPV-16 and anti-HPV-18. All schedules elicited sustained immune responses up to M36. Conclusions. Both 2-dose schedules in young girls remained noninferior to the 3-dose schedule in women up to study conclusion at M36. The AS04-HPV-16/18 vaccine administered as a 2-dose schedule was immunogenic and well tolerated in young girls.
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Affiliation(s)
- Li-Min Huang
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University, Taipei
| | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, and Research Unit in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Thailand
| | - Chiu Cheng-Hsun
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan
| | - Tang Ren-Bin
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tino Schwarz
- Central Laboratory and Vaccination Centre, Klinikum Würzburg Mitte, Standort Juliusspital, Würzburg
| | - Angelo Pellegrino
- Department Distretto di Dronero, Azienda Sanitaria Locale Cuneo 1, Cuneo
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan
| | | | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax
| | - Paolo Durando
- Department of Health Sciences, University of Genoa and IRCCS AOU San Martino-IST, Genoa
| | | | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | | | - Karl Ulrich Petry
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg
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Aung ET, Fairley CK, Tabrizi SN, Danielewski JA, Ong JJ, Chen MY, Bradshaw CS, Chow EPF. Detection of human papillomavirus in urine among heterosexual men in relation to location of genital warts and circumcision status. Sex Transm Infect 2017; 94:222-225. [PMID: 28866637 DOI: 10.1136/sextrans-2016-053031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/01/2017] [Accepted: 08/07/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Human papillomavirus (HPV) surveillance is important to monitor the effectiveness of national HPV vaccination programmes. Positivity of HPV in urine in men varies with different sampling methods. We aimed to determine the positivity for detection of HPV-6/11 in urine samples among men in relation to the position of genital warts and circumcision status. METHOD We analysed stored chlamydia-positive urine specimens in young heterosexual men aged less than 25 years attending Melbourne Sexual Health Centre, Australia, between 2004 and 2015, for HPV genotypes. Positivity of HPV-6/11 and high-risk genotypes were stratified according to the position of genital warts and circumcision status. Positivity of HPV-6/11 was calculated using diagnosis of warts as the gold standard. Warts were classified as proximal penile warts from suprapubic area to midshaft of penis, and distal penile warts from distal shaft of penis to meatus. RESULTS Of the 934 specimens, 253 (27.1%) men were positive for any HPV and 82 men (8.8%) had genital warts. The ORs of HPV-6/11 detection in urine were 4.63 (95% CI: 1.68 to 12.78) and 40.20 (95% CI: 19.78 to 81.70) times higher among men who had proximal penile warts and distal penile warts, respectively, compared with men who did not have genital warts. Circumcised men were less likely to have high-risk HPV (OR 0.31; 95% CI: 0.14 to 0.65) than uncircumcised men. Uncircumcised men were more likely to have distal penile warts than circumcised men (OR 8.22; 95% CI: 1.34 to 337.46). CONCLUSION Positivity of HPV-6/11 in urine increases greatly in men with distal penile warts. Circumcised men are less likely to have distal penile warts, any HPV or high-risk HPV detected. Urine is likely to be an alternative sampling method for HPV-6/11 surveillance programme in men in countries with low circumcision rates.
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Affiliation(s)
- Ei T Aung
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sepehr N Tabrizi
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer A Danielewski
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Marcus Y Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Catriona S Bradshaw
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Improving skills and institutional capacity to strengthen adolescent immunisation programmes and health systems in African countries through HPV vaccine introduction. PAPILLOMAVIRUS RESEARCH 2017; 4:66-71. [PMID: 29179872 DOI: 10.1016/j.pvr.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 02/04/2023]
Abstract
Several African countries have recently introduced or are currently introducing the HPV vaccine, either nationwide or through demonstration projects, while some countries are planning for introduction. A collaborative project was developed to strengthen country adolescent immunisation programmes and health systems in the African Region, addressing unique public health considerations of HPV vaccination: adolescents as the primary target group, delivery platforms (e.g. school-based and facility based), socio-behavioural issues, and the opportunity to deliver other health interventions alongside HPV vaccination. Following a successful "taking-stock" meeting, a training programme was drafted to assist countries to strengthen the integration of adolescent health interventions using HPV vaccination as an entry point. Two workshops were conducted in the Eastern and Southern African Regions. All countries reported on progress made during a final joint symposium. Of the 20 countries invited to participate in either of the workshops and/or final symposium, 17 countries participated: Angola, Botswana, Ethiopia, Kenya, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. Countries that are currently implementing HPV vaccination programmes, either nationally or through demonstration projects, reported varying degrees of integration with other adolescent health interventions. The most commonly reported adolescent health interventions alongside HPV vaccination include health education (including sexually transmitted infections), deworming and delivering of other vaccines like tetanus toxoid (TT) or tetanus diphtheria (Td). The project has successfully (a) established an African-based network that will advocate for incorporating the HPV vaccine into national immunisation programmes; (b) created a platform for experience exchange and thereby contributed to novel ideas of revitalising and strengthening school-based health programmes as delivery platform of adolescent immunisation services and other adolescent health interventions, as well as identifying ways of reaching out-of-school girls through facility and community based programmes; and (c) laid a foundation for incorporating future adolescent vaccination programmes.
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81
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Oliver SE, Unger ER, Lewis R, McDaniel D, Gargano JW, Steinau M, Markowitz LE. Prevalence of Human Papillomavirus Among Females After Vaccine Introduction-National Health and Nutrition Examination Survey, United States, 2003-2014. J Infect Dis 2017; 216:594-603. [PMID: 28931217 PMCID: PMC5740482 DOI: 10.1093/infdis/jix244] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/16/2017] [Indexed: 11/12/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccine was recommended in 2006 for routine vaccination of US females aged 11-12 years. Most vaccine used through 2014 was quadrivalent vaccine (4vHPV), which prevents HPV-6, -11, -16, and -18 infection. To evaluate vaccine impact, we measured HPV prevalence in the National Health and Nutrition Examination Survey (NHANES). Methods We analyzed HPV DNA types detected in self-collected cervicovaginal specimens and demographic, sexual behavior, and self-reported vaccination data from females 14-34 years old. We estimated HPV prevalence in the prevaccine (2003-2006) and vaccine eras (2007-2010 and 2011-2014). Results Among 14- to 19-year-olds, 4vHPV-type prevalence decreased from 11.5% (95% confidence interval [CI], 9.1%-14.4%) in 2003-2006 to 3.3% (95% CI, 1.9%-5.8%) in 2011-2014, when ≥1-dose coverage was 55%. Among 20- to 24-year-olds, prevalence decreased from 18.5% (95% CI, 14.9%-22.8%) in 2003-2006 to 7.2% (95% CI, 4.7%-11.1%) in 2011-2014, when ≥1-dose coverage was 43%. Compared to 2003-2006, 4vHPV prevalence in sexually active 14- to 24-year-olds in 2011-2014 decreased 89% among those vaccinated and 34% among those unvaccinated. Vaccine effectiveness was 83%. Conclusions Within 8 years of vaccine introduction, 4vHPV-type prevalence decreased 71% among 14- to 19-year-olds and 61% among 20- to 24-year-olds. Estimated vaccine effectiveness was high. The decrease in 4vHPV-type prevalence among unvaccinated females suggests herd protection.
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Affiliation(s)
- Sara E Oliver
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rayleen Lewis
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Darius McDaniel
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Julia W Gargano
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
| | - Martin Steinau
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases
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de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer 2017; 141:664-670. [PMID: 28369882 PMCID: PMC5520228 DOI: 10.1002/ijc.30716] [Citation(s) in RCA: 1284] [Impact Index Per Article: 183.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/24/2017] [Indexed: 01/01/2023]
Abstract
HPV is the cause of almost all cervical cancer and is responsible for a substantial fraction of other anogenital cancers and oropharyngeal cancers. Understanding the HPV-attributable cancer burden can boost programs of HPV vaccination and HPV-based cervical screening. Attributable fractions (AFs) and the relative contributions of different HPV types were derived from published studies reporting on the prevalence of transforming HPV infection in cancer tissue. Maps of age-standardized incidence rates of HPV-attributable cancers by country from GLOBOCAN 2012 data are shown separately for the cervix, other anogenital tract and head and neck cancers. The relative contribution of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 was also estimated. 4.5% of all cancers worldwide (630,000 new cancer cases per year) are attributable to HPV: 8.6% in women and 0.8% in men. AF in women ranges from <3% in Australia/New Zealand and the USA to >20% in India and sub-Saharan Africa. Cervix accounts for 83% of HPV-attributable cancer, two-thirds of which occur in less developed countries. Other HPV-attributable anogenital cancer includes 8,500 vulva; 12,000 vagina; 35,000 anus (half occurring in men) and 13,000 penis. In the head and neck, HPV-attributable cancers represent 38,000 cases of which 21,000 are oropharyngeal cancers occurring in more developed countries. The relative contributions of HPV16/18 and HPV6/11/16/18/31/33/45/52/58 are 73% and 90%, respectively. Universal access to vaccination is the key to avoiding most cases of HPV-attributable cancer. The preponderant burden of HPV16/18 and the possibility of cross-protection emphasize the importance of the introduction of more affordable vaccines in less developed countries.
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Affiliation(s)
| | | | - Jerome Vignat
- International Agency for Research on CancerLyonFrance
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83
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Maver PJ, Poljak M. Progress in prophylactic human papillomavirus (HPV) vaccination in 2016: A literature review. Vaccine 2017; 36:5416-5423. [PMID: 28801154 DOI: 10.1016/j.vaccine.2017.07.113] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022]
Abstract
Prophylactic human papillomavirus (HPV) vaccine represents a revolutionary step forward in preventing HPV-related cancers, especially cervical carcinoma. Alongside appropriate screening, it has the potential to dramatically reduce cervical cancer incidence and even eradicate it. Following extensive evaluations in clinical trials, the first decade of routine HPV vaccine use provides overwhelming evidence of the vaccines' safety and their real-life effectiveness. In 2016, further clinical trials showed high vaccine efficacy in adult women, especially those that were HPV DNA-negative at baseline, and indicated possible protection from HPV-related diseases after treatment of precancerous cervical lesions. The recommendation for a two-dose schedule in individuals under 15 is further supported for all three licensed vaccines by immunogenicity studies that show non-inferior immune responses and similar clinical efficacy compared to the three-dose schedule. So far, natural competition between HPV types has not been confirmed and therefore vaccine-induced clinically significant type replacement is unlikely. The real-world effectiveness data showed cross-sectional reduction in the prevalence/incidence of vaccine-related HPV types, genital warts and precancerous cervical lesions in countries and regions with HPV vaccination coverage. These declines were evident not only in vaccinated females, but also in unvaccinated females and males, strongly suggesting herd protection. Despite an excellent safety profile consistently demonstrated in clinical trials and confirmed in real-life settings, recently invented controversial syndromes allegedly linked to HPV vaccines temporarily compromised some previously very successful vaccination programs and significantly contributed to the failure of HPV vaccine implementation in some countries with the highest prevalence of cervical cancer. However, several safety studies failed to confirm any association of these syndromes with HPV vaccination in various settings and geographic locations. The main challenges remain implementing HPV vaccination in national vaccination programs, especially in low-and middle-income countries with the highest burden of cervical cancer, and achieving and sustaining high vaccine coverage rates.
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Affiliation(s)
- Polona J Maver
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
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Baussano I, Lazzarato F, Ronco G, Lehtinen M, Dillner J, Franceschi S. Different Challenges in Eliminating HPV16 Compared to Other Types: A Modeling Study. J Infect Dis 2017; 216:336-344. [PMID: 28859431 PMCID: PMC5853887 DOI: 10.1093/infdis/jix299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Human papillomavirus (HPV) vaccination is still not reaching many high-risk populations. HPV16/18 vaccines offer cross-protection against other types, for example, HPV45. Both direct vaccine efficacy and indirect herd protection contribute to vaccination effectiveness. Methods We used a dynamic transmission model, calibrated to cervical screening data from Italy, to estimate vaccination effectiveness against HPV16 and HPV45 infection, assuming for HPV45 either 95% or lower cross-protection. Results Basic reproductive number was smaller (2.1 vs 4.0) and hence vaccine effectiveness and herd protection stronger for HPV45 than for HPV16. The largest difference in the reduction of infection prevalence in women <35 years old was found at 70% coverage in girls-only vaccination programs (99% vs 83% for total protection for HPV45 and HPV16, respectively, mainly owing to stronger herd protection, ie, 37% vs 16%). In gender-neutral vaccination, the largest difference was at 40% coverage (herd protection, 54% vs 28% for HPV16 and HPV45, respectively). With ≥80% coverage, even 50% cross-protection would reduce HPV45 by ≥94%. Conclusions The characteristics of individual high-risk HPV types strongly influence herd protection and determine the level of coverage and cross-protection required to reduce or eliminate the infection through HPV vaccination. HPV16 infection and related cancers are the most difficult to eliminate.
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Affiliation(s)
| | - Fulvio Lazzarato
- International Agency for Research on Cancer, Lyon, France
- Unit of Cancer Epidemiology, AOU Città della Salute e della Scienza, Hospital of Turin
| | - Guglielmo Ronco
- Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology, Turin, Italy
| | - Matti Lehtinen
- University of Tampere, Finland
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
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85
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LaMontagne DS, Bloem PJ, Brotherton JM, Gallagher KE, Badiane O, Ndiaye C. Progress in HPV vaccination in low- and lower-middle-income countries. Int J Gynaecol Obstet 2017; 138 Suppl 1:7-14. [DOI: 10.1002/ijgo.12186] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Julia M.L. Brotherton
- National HPV Vaccination Program Register; VCS Ltd; Melbourne Vic. Australia
- School of Population and Global Health; University of Melbourne; Melbourne Victoria Australia
| | | | - Ousseynou Badiane
- Division de l'Immunisation; Ministère de la Santé et de l'Action Sociale; Dakar Senegal
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86
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Barroeta JE, Adhikari-Guragain D, Grotkowski CE. Cervical cancer screening in the era of HPV vaccination: A review of shifting paradigms in cytopathology. Diagn Cytopathol 2017; 45:903-914. [PMID: 28589649 DOI: 10.1002/dc.23737] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/16/2017] [Accepted: 04/07/2017] [Indexed: 01/14/2023]
Abstract
Significant changes in cervical cancer screening practice, guidelines, and prevention of cervical cancer have taken place in recent years including the raising of initial cervical cancer screening age, changes in frequency of cytology screening, and the adoption of high risk HPV and cytology co-testing for some patients; the introduction of the bivalent, quadrivalent, and 9-valent HPV vaccines; and the recent approval of high risk HPV testing as primary screening with the use of cytology as triage in positive cases. This review discusses the significance of primary HPV screening, the impact of HPV vaccination in the prevalence of cervical cancer and its precursors, the interplay between high risk HPV testing and vaccination, and the implications for clinical and cytological management. Future strategies for cervical screening in the post-vaccination era are also discussed.
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Affiliation(s)
- Julieta E Barroeta
- Department of Pathology, Cooper University Hospital, M.D. Anderson Cancer Center at Cooper, Camden, New Jersey
| | - Deepti Adhikari-Guragain
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carolyn E Grotkowski
- Department of Pathology, Cooper University Hospital, M.D. Anderson Cancer Center at Cooper, Camden, New Jersey
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87
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Tanton C, Mesher D, Beddows S, Soldan K, Clifton S, Panwar K, Field N, Mercer CH, Johnson AM, Sonnenberg P. Human papillomavirus (HPV) in young women in Britain: Population-based evidence of the effectiveness of the bivalent immunisation programme and burden of quadrivalent and 9-valent vaccine types. PAPILLOMAVIRUS RESEARCH 2017. [PMID: 28626810 PMCID: PMC5462921 DOI: 10.1016/j.pvr.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background In 2008, the UK introduced an HPV immunisation programme in girls. Population-based prevalence estimates of bivalent (HPV-16/18), quadrivalent (HPV-6/11/16/18) and 9-valent (HPV-6/11/16/18/31/33/45/52/58) vaccine types, and comparison over time, are needed to monitor impact, evaluate effectiveness and guide decision-making on vaccination strategies. Methods The third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) in 2010-12, tested urine for HPV from 2569 sexually-experienced women aged 16–44. We report type-specific HPV prevalence and compare results with 1798 women in Natsal-2 (1999–2001) using age-adjusted prevalence ratios (APR). Findings In Natsal-3, 4.2% of women aged 16-44y were positive for HPV‐16/18 and 2.9% for HPV-6/11. In 16–20 year olds, 4.5%, 10.8% and 20.7% had at least one bivalent, quadrivalent or 9-valent vaccine type, respectively. Three-dose vaccine coverage was 52.0% in women aged 18-20y. In this age group, HPV-16/18 prevalence was lower in Natsal-3 than Natsal-2 (5.8% vs 11.2%; APR=0.48[95%CI: 0.24–0.93]), however, prevalences of HPV-6/11, HPV-31/33/45 and HPV-52/58 were unchanged. HPV-16/18 prevalence was also unchanged in women aged 21-44y (APR=0.85[0.61–1.19]). Interpretation These probability surveys provide evidence of the impact of the bivalent immunisation programme. Reductions were specific to HPV-16/18 and to the age group eligible for vaccination. However, substantial vaccine-preventable HPV remains.
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Affiliation(s)
- Clare Tanton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - David Mesher
- Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Simon Beddows
- Virus Reference Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Kate Soldan
- Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Soazig Clifton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK; NatCen Social Research, 35 Northampton Square, London EC1V 0AX, UK.
| | - Kavita Panwar
- Virus Reference Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Nigel Field
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
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88
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Ginindza TG, Sartorius B, Dlamini X, Östensson E. Cost analysis of Human Papillomavirus-related cervical diseases and genital warts in Swaziland. PLoS One 2017; 12:e0177762. [PMID: 28531205 PMCID: PMC5439687 DOI: 10.1371/journal.pone.0177762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has proven to be the cause of several severe clinical conditions on the cervix, vulva, vagina, anus, oropharynx and penis. Several studies have assessed the costs of cervical lesions, cervical cancer (CC), and genital warts. However, few have been done in Africa and none in Swaziland. Cost analysis is critical in providing useful information for economic evaluations to guide policymakers concerned with the allocation of resources in order to reduce the disease burden. MATERIALS AND METHODS A prevalence-based cost of illness (COI) methodology was used to investigate the economic burden of HPV-related diseases. We used a top-down approach for the cost associated with hospital care and a bottom-up approach to estimate the cost associated with outpatient and primary care. The current study was conducted from a provider perspective since the state bears the majority of the costs of screening and treatment in Swaziland. All identifiable direct medical costs were considered for cervical lesions, cervical cancer and genital warts, which were primary diagnoses during 2015. A mix of bottom up micro-costing ingredients approach and top-down approaches was used to collect data on costs. All costs were computed at the price level of 2015 and converted to dollars ($). RESULTS The total annual estimated direct medical cost associated with screening, managing and treating cervical lesions, CC and genital warts in Swaziland was $16 million. The largest cost in the analysis was estimated for treatment of high-grade cervical lesions and cervical cancer representing 80% of the total cost ($12.6 million). Costs for screening only represented 5% of the total cost ($0.9 million). Treatment of genital warts represented 6% of the total cost ($1million). CONCLUSION According to the cost estimations in this study, the economic burden of HPV-related cervical diseases and genital warts represents a major public health issue in Swaziland. Prevention of HPV infection with a national HPV immunization programme for pre-adolescent girls would prevent the majority of CC related deaths and associated costs.
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Affiliation(s)
- Themba G. Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Benn Sartorius
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Ellinor Östensson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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89
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Cruickshank ME, Pan J, Cotton SC, Kavanagh K, Robertson C, Cuschieri K, Cubie H, Palmer T, Pollock KG. Reduction in colposcopy workload and associated clinical activity following human papillomavirus (HPV) catch-up vaccination programme in Scotland: an ecological study. BJOG 2017; 124:1386-1393. [DOI: 10.1111/1471-0528.14562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 01/08/2023]
Affiliation(s)
- ME Cruickshank
- Department of Obstetrics and Gynaecology; University of Aberdeen; Aberdeen UK
| | - J Pan
- Department of Mathematics and Statistics; University of Strathclyde; Glasgow UK
| | - SC Cotton
- Department of Obstetrics and Gynaecology; University of Aberdeen; Aberdeen UK
| | - K Kavanagh
- Department of Mathematics and Statistics; University of Strathclyde; Glasgow UK
| | - C Robertson
- Department of Mathematics and Statistics; University of Strathclyde; Glasgow UK
- Health Protection Scotland; Glasgow UK
| | - K Cuschieri
- Scottish Human Papillomavirus Reference Laboratory; Edinburgh UK
| | - H Cubie
- Scottish Human Papillomavirus Reference Laboratory; Edinburgh UK
| | - T Palmer
- Department of Pathology; University of Edinburgh; Edinburgh UK
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90
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No evidence for cross-protection of the HPV-16/18 vaccine against HPV-6/11 positivity in female STI clinic visitors. J Infect 2017; 74:393-400. [PMID: 28126492 DOI: 10.1016/j.jinf.2017.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Data from a vaccine trial and from post-vaccine surveillance in the United Kingdom have suggested that the bivalent HPV-16/18 vaccine offers cross-protection against HPV-6/11 and protection against anogenital warts (AGW). We studied the effect of the bivalent vaccine on genital HPV-6/11 positivity and AGW in the Netherlands. METHODS We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional study among 16- to 24-year-old sexually transmitted infection (STI) clinic attendants. Vaginal self-swabs were analyzed for type specific HPV and AGW were diagnosed at the STI-clinic. Prevalence of HPV-6 and/or HPV-11 and AGW were compared between self-reported vaccinated and unvaccinated women by log-binomial regression analysis, adjusted for demographics and risk behavior. RESULTS Of the 1198 women included, 56% reported to be vaccinated at least once. Relative to unvaccinated women, the adjusted prevalence ratio (PR) for HPV-6/11 was 1.03 (95% confidence interval [CI] 0.74-1.43) for women vaccinated at least once. The crude PR for AGW was 0.67 (95% CI 0.22-2.07) for women vaccinated at least once. Adjustment did not change these results. CONCLUSIONS We observed no cross-protective effect of the bivalent vaccine on genital HPV-6/11 positivity and a non-significant partially protective effect on AGW.
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91
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Conway DI, Robertson C, Gray H, Young L, McDaid LM, Winter AJ, Campbell C, Pan J, Kavanagh K, Kean S, Bhatia R, Cubie H, Clarkson JE, Bagg J, Pollock KG, Cuschieri K. Human Papilloma Virus (HPV) Oral Prevalence in Scotland (HOPSCOTCH): A Feasibility Study in Dental Settings. PLoS One 2016; 11:e0165847. [PMID: 27861508 PMCID: PMC5115665 DOI: 10.1371/journal.pone.0165847] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/18/2016] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to test the feasibility of undertaking a full population investigation into the prevalence, incidence, and persistence of oral Human Papilloma Virus (HPV) in Scotland via dental settings. Male and female patients aged 16–69 years were recruited by Research Nurses in 3 primary care and dental outreach teaching centres and 2 General Dental Practices (GDPs), and by Dental Care Teams in 2 further GDPs. Participants completed a questionnaire (via an online tablet computer or paper) with socioeconomic, lifestyle, and sexual history items; and were followed up at 6-months for further questionnaire through appointment or post/online. Saline oral gargle/rinse samples, collected at baseline and follow-up, were subject to molecular HPV genotyping centrally. 1213 dental patients were approached and 402 individuals consented (participation rate 33.1%). 390 completed the baseline questionnaire and 380 provided a baseline oral specimen. Follow-up rate was 61.6% at 6 months. While recruitment was no different in Research Nurse vs Dental Care Team models the Nurse model ensured more rapid recruitment. There were relatively few missing responses in the questionnaire and high levels of disclosure of risk behaviours (99% answered some of the sexual history questions). Data linkage of participant data to routine health records including HPV vaccination data was successful with 99.1% matching. Oral rinse/gargle sample collection and subsequent HPV testing was feasible. Preliminary analyses found over 95% of samples to be valid for molecular HPV detection prevalence of oral HPV infection of 5.5% (95%CI 3.7, 8.3). It is feasible to recruit and follow-up dental patients largely representative / reflective of the wider population, suggesting it would be possible to undertake a study to investigate the prevalence, incidence, and determinants of oral HPV infection in dental settings.
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Affiliation(s)
- David I. Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Chris Robertson
- Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Heather Gray
- Glasgow Caledonian University, Glasgow, United Kingdom
| | - Linda Young
- NHS Education for Scotland, Dundee, United Kingdom
| | - Lisa M. McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Andrew J. Winter
- Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde Health Board, Glasgow, United Kingdom
| | - Christine Campbell
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jiafeng Pan
- Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Kimberley Kavanagh
- Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom
| | - Sharon Kean
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, United Kingdom
| | - Ramya Bhatia
- Human Papillomavirus Research Group, Division of Pathology, University of Edinburgh, Edinburgh, United Kingdom
| | - Heather Cubie
- Human Papillomavirus Research Group, Division of Pathology, University of Edinburgh, Edinburgh, United Kingdom
| | - Jan E. Clarkson
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Jeremy Bagg
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Kevin G. Pollock
- Health Protection Scotland, National Services Scotland, Glasgow, United Kingdom
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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92
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Saslow D, Andrews KS, Manassaram-Baptiste D, Loomer L, Lam KE, Fisher-Borne M, Smith RA, Fontham ETH. Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement. CA Cancer J Clin 2016; 66:375-85. [PMID: 27434803 PMCID: PMC5555157 DOI: 10.3322/caac.21355] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Answer questions and earn CME/CNE The American Cancer Society (ACS) reviewed and updated its guideline on human papillomavirus (HPV) vaccination based on a methodologic and content review of the Advisory Committee on Immunization Practices (ACIP) HPV vaccination recommendations. A literature review was performed to supplement the evidence considered by the ACIP and to address new vaccine formulations and recommendations as well as new data on population outcomes since publication of the 2007 ACS guideline. The ACS Guideline Development Group determined that the evidence supports ACS endorsement of the ACIP recommendations, with one qualifying statement related to late vaccination. The ACS recommends vaccination of all children at ages 11 and 12 years to protect against HPV infections that lead to several cancers and precancers. Late vaccination for those not vaccinated at the recommended ages should be completed as soon as possible, and individuals should be informed that vaccination may not be effective at older ages. CA Cancer J Clin 2016;66:375-385. © 2016 American Cancer Society.
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Affiliation(s)
- Debbie Saslow
- Director, Cancer Control Intervention, Human Papillomavirus and Women’s Cancers, American Cancer Society, Atlanta, GA
| | | | | | - Lacey Loomer
- Graduate Student, Emory University Rollins School of Public Health, Atlanta, GA
| | - Kristina E. Lam
- Medical Epidemiologist, Georgia Department of Public Health, Atlanta, GA
| | - Marcie Fisher-Borne
- Program Director, Human Papillomavirus Vaccination, American Cancer Society, Atlanta, GA
| | - Robert A. Smith
- Vice President, Cancer Screening, American Cancer Society, Atlanta, GA
| | - Elizabeth T. H. Fontham
- Founding Dean and Professor Emeritus, Louisiana State University School of Public Health, New Orleans, LA
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93
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Brotherton JML, Zuber PLF, Bloem PJN. Primary Prevention of HPV through Vaccination: Update on the Current Global Status. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0165-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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94
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Taylor S, Ryser M, Mihalyi A, van Effelterre T. Response letter regarding the letter to the editors by Brown et al. Hum Vaccin Immunother 2016; 12:1943-6. [PMID: 27163545 PMCID: PMC4964815 DOI: 10.1080/21645515.2016.1151598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Palmer TJ, McFadden M, Pollock KGJ, Kavanagh K, Cuschieri K, Cruickshank M, Nicoll S, Robertson C. HPV immunisation and increased uptake of cervical screening in Scottish women; observational study of routinely collected national data. Br J Cancer 2016; 114:576-81. [PMID: 26794278 PMCID: PMC4782202 DOI: 10.1038/bjc.2015.473] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To measure the uptake of first invitation to cervical screening by vaccine status in a population-based cohort offered HPV immunisation in a national catch-up campaign. METHODS A retrospective observational study of routinely collected data from the Scottish Cervical Screening Programme. Data were extracted and linked from the Scottish Cervical Call Recall System, the Scottish Population Register and the Scottish Index of Multiple Deprivation. Records from 201 023 women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. Attendance for screening was within 12 months of the first invitation at age 20 years. RESULTS There was a significant decline in overall attendance from the 1988 cohort to the 1993 cohort with the adjusted attendance ratio of the 1988 cohort being 1.49 times (95% CI 1.46-1.52) that of the 1993 cohort. Immunisation compensated for this decrease in uptake with unvaccinated individuals having a reduced ratio of attendance compared with those fully vaccinated (RR=0.65, 95% CI 0.64-0.65). Not taking up the opportunity for HPV immunisation was associated with an attendance for screening below the trend line for all women before the availability of HPV immunisation. CONCLUSIONS HPV immunisation is not associated with the reduced attendance for screening that had been feared. Immunised women in the catch-up cohorts appear to be more motivated to attend than unimmunised women, but this may be a result of a greater awareness of health issues. These results, while reassuring, may not be reproduced in routinely immunised women. Continued monitoring of attendance for the first smear and subsequent routine smears is needed.
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Affiliation(s)
- T J Palmer
- Department of Pathology, University of Edinburgh, EH16 4SA, University of Edinburgh, Edinburgh, Scotland
| | - M McFadden
- Information Services Division, NHS National Services Scotland, Gyle Square, Edinburgh EH12 9EB, UK
| | - K G J Pollock
- Health Protection Scotland, Glasgow G2 6QE, Scotland
| | - K Kavanagh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, Scotland
| | - K Cuschieri
- Scottish Human Papillomavirus Reference Laboratory, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, Scotland
| | - M Cruickshank
- Department of Gynaecology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZD, Scotland
| | - S Nicoll
- Department of Cytology, Ninewells Hospital, Dundee DD1 9SY, Scotland
| | - C Robertson
- Health Protection Scotland, Glasgow G2 6QE, Scotland
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, Scotland
- International Prevention Research Institute, Lyon, France
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96
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Bhatia R, Kavanagh K, Cubie HA, Serrano I, Wennington H, Hopkins M, Pan J, Pollock KG, Palmer TJ, Cuschieri K. Use of HPV testing for cervical screening in vaccinated women--Insights from the SHEVa (Scottish HPV Prevalence in Vaccinated Women) study. Int J Cancer 2016; 138:2922-31. [PMID: 26845632 DOI: 10.1002/ijc.30030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/29/2015] [Accepted: 01/19/2016] [Indexed: 11/08/2022]
Abstract
The management of cervical disease is changing worldwide as a result of HPV vaccination and the increasing use of HPV testing for cervical screening. However, the impact of vaccination on the performance of HPV based screening strategies is unknown. The SHEVa (Scottish HPV Prevalence in Vaccinated women) projects are designed to gain insight into the impact of vaccination on the performance of clinically validated HPV assays. Samples collated from women attending for first cervical smear who had been vaccinated as part of a national "catch-up" programme were tested with three clinically validated HPV assays (2 DNA and 1 RNA). Overall HR-HPV and type specific positivity was assessed in total population and according to underlying cytology and compared to a demographically equivalent group of unvaccinated women. HPV prevalence was significantly lower in vaccinated women and was influenced by assay-type, reducing by 23-25% for the DNA based assays and 32% for the RNA assay (p = 0.0008). All assays showed over 75% reduction of HPV16 and/or 18 (p < 0.0001) whereas the prevalence of non 16/18 HR-HPV was not significantly different in vaccinated vs unvaccinated women. In women with low grade abnormalities, the proportion associated with non 16/18 HR-HPV was significantly higher in vaccinated women (p < 0.0001). Clinically validated HPV assays are affected differentially when applied to vaccinated women, dependent on assay chemistry. The increased proportion of non HPV16/18 infections may have implications for clinical performance, consequently, longitudinal studies linking HPV status to disease outcomes in vaccinated women are warranted.
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Affiliation(s)
- Ramya Bhatia
- HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom
| | - Kimberley Kavanagh
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, United Kingdom
| | - Heather Ann Cubie
- HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom.,Global Health Academy, University of Edinburgh, Edinburgh, United Kingdom
| | - Itziar Serrano
- HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom
| | - Holli Wennington
- HPV Research Group, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Hopkins
- Liverpool Clinical Laboratories, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Jiafeng Pan
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, United Kingdom
| | | | - Tim J Palmer
- Department of Pathology, University of Edinburgh, Edinburgh, United Kingdom
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, United Kingdom
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HPV immunisation and cervical screening--confirmation of changed performance of cytology as a screening test in immunised women: a retrospective population-based cohort study. Br J Cancer 2016; 114:582-9. [PMID: 26931370 PMCID: PMC4782203 DOI: 10.1038/bjc.2015.474] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/03/2015] [Accepted: 12/09/2015] [Indexed: 11/08/2022] Open
Abstract
Background: To document the effect of bivalent HPV immunisation on cervical cytology as a screening test and assess the implications of any change, using a retrospective analysis of routinely collected data from the Scottish Cervical Screening Programme (SCSP). Methods: Data were extracted from the Scottish Cervical Call Recall System (SCCRS), the Scottish Population Register and the Scottish Index of Multiple Deprivation. A total of 95 876 cytology records with 2226 linked histology records from women born between 1 January 1988 and 30 September 1993 were assessed. Women born in or after 1990 were eligible for the national catch-up programme of HPV immunisation. The performance of cervical cytology as a screening test was evaluated using the key performance indicators used routinely in the English and Scottish Cervical Screening Programmes (NHSCSP and SCSP), and related to vaccination status. Results: Significant reductions in positive predictive value (16%) and abnormal predictive value (63%) for CIN2+ and the mean colposcopy score (18%) were observed. A significant increase (38%) in the number of women who had to be referred to colposcopy to detect one case of CIN2+ was shown. The negative predictive value of negative- or low-grade cytology for CIN2+ increased significantly (12%). Sensitivity and specificity, as used by the UK cervical screening programmes, were maintained. Conclusions: The lower incidence of disease in vaccinated women alters the key performance indicators of cervical cytology used to monitor the quality of the screening programme. These findings have implications for screening, colposcopy referral criteria, colposcopy practice and histology reporting.
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