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Dykens JA, Peterson CE, Holt HK, Harper DM. Gender neutral HPV vaccination programs: Reconsidering policies to expand cancer prevention globally. Front Public Health 2023; 11:1067299. [PMID: 36895694 PMCID: PMC9989021 DOI: 10.3389/fpubh.2023.1067299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Human papillomavirus (HPV) infection is responsible for many cancers in both women and men. Cervical cancer, caused by HPV, is the fourth most common cancer among women worldwide, even though it is one of the most preventable cancers. Prevention efforts include HPV vaccination, however these programs remain nascent in many countries. In 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination including a goal to fully vaccinate 90% of girls with the HPV vaccine by the age of 15. However, very few countries have reached even 70% coverage. Increased vaccine availability in the future may allow the opportunity to vaccinate more people. This could add to the feasibility of introducing gender-neutral HPV vaccination programs. Adopting a gender-neutral HPV vaccine approach will reduce HPV infections transmitted among the population, combat misinformation, minimize vaccine-related stigma, and promote gender equity. We propose approaching programmatic research through a gender-neutral lens to reduce HPV infections and cancers and promote gender equality. In order to design more effective policies and programs, a better understanding of the perspectives of clients, clinicians, community leaders, and policy-makers is needed. A clear, multi-level understanding of these stakeholders' views will facilitate the development of target policy and programs aimed at addressing common barriers and optimizing uptake. Given the benefit of developing gender-neutral HPV vaccination programs to eliminate cervical cancer and address other HPV associated cancers, we must build knowledge through implementation research around this topic to inform policy-makers and funders for future policy shifts.
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Affiliation(s)
- J Andrew Dykens
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Caryn E Peterson
- Center for Global Health, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Hunter K Holt
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, United States.,Cancer Center, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Diane M Harper
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Obstetrics & Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Women's Studies, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI, United States
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Kosumi E, Kosumi M, Spasovski M. Attitude and practice on Human Papillomavirus, Human Papillomavirus Vaccine and associated factors among population in the Republic of Kosova. Arch Public Health 2022. [DOI: 10.3889/aph.2022.6067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Аpproximately 50–80% of sexually active women are exposed to at least one HPV variant during their lifetime. Based on the 2015 annual report of the National Institute of Public Health of Kosova, 68 new cases of cervical cancer were detected. The aim of the study was to investigate the attitude and practice regarding Human Papillomavirus (HPV) infections and the Human Papillomavirus vaccine in the population of the Republic of Kosova. Material and methods: A cross-sectional survey was conducted to assess the knowledge concerning HPV infections among the population aged 18 to 35+ years. The study was conducted during the period of time June 2021 –to August 2021. The sample included 500 participants. The questionnaire was anonymous, and participants were free to end their participation any time, without completing the questionnaire. Results: Regarding the claim "The HPV vaccine is safe", more than half of the respondents, respectively58.6% declare that they do not know, 33.4% of the respondents agree, 6.0% gave an incorrect answer / disagree, and 2.0% did not answer. The percentage difference between the unknown and correct answers is statistically significant for p<0.05. Conclusion: This study found out that the attitude towards the HPV vaccine among people of the Republic of Kosova is low to moderate. HPV vaccines should be included in the national immunization programs, since there is not still established national vaccination program for HPV vaccination.
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Strong C, Yu YF, Zou H, Ku WW, Lee CW, Ko NY. Sexual network and detection of anogenital human papillomavirus in a community cohort of men who have sex with men in Taiwan. PLoS One 2019; 14:e0216784. [PMID: 31075133 PMCID: PMC6510428 DOI: 10.1371/journal.pone.0216784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/29/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We examined the association between anogenital human papillomavirus (HPV) infection and sexual networks in men who have sex with men (MSM). METHODS A total of 253 MSM, 20 years of age and older, were recruited from the community in Southern Taiwan in 2015-2016. At baseline and at each follow-up visit, MSM were screened for HPV to identify 37 HPV genotypes. At the six-month follow-up, MSM were asked to fill out an egocentric network assessment and to report the last five persons with whom they had sex regarding the characteristics of sexual behavior with each network member. RESULTS A total of 182 participants (71.9%) returned for the follow-up and one third had at least one HPV type detected. A higher level of bridging network position calculated by the level of constraints in the network was significantly less likely to have HPV detection at the anal site. A high level of concurrency was associated with penile HPV detection (AOR = 3.16, 95% CI = 1.01-9.86). CONCLUSIONS Identifying network-related characteristics can advance our understanding of high-risk populations and for prioritizing HPV vaccine recommendations.
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Affiliation(s)
- Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
| | - Yi-Fang Yu
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Wen-Wei Ku
- Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Wen Lee
- Fengshan Lee Chia Wen Urologic Clinic, Kaohsiung, Taiwan
| | - Nai-Ying Ko
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Nursing, National Cheng Kung University and Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Qendri V, Schurink-Van 't Klooster TM, Bogaards JA, Berkhof J. Ten years of HPV vaccination in the Netherlands: current evidence and future challenges in HPV-related disease prevention. Expert Rev Vaccines 2018; 17:1093-1104. [PMID: 30417704 DOI: 10.1080/14760584.2018.1547196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Girls-only vaccination against human papillomavirus (HPV) type 16 and 18 was implemented in the Netherlands in 2009. Despite the evidence of the efficacy against precancerous lesions, cross-protection induced by the vaccine and a greater potential for cancer prevention than cervical cancer only, vaccine coverage in the girls-only program has remained below target levels. AREAS COVERED In this paper, we review the literature from the Netherlands on the effectiveness and cost-effectiveness of HPV vaccination since vaccine introduction, give an account of the coverage, safety and effectiveness of HPV vaccination as has been reported in the Dutch surveillance program and discuss challenges of the current HPV vaccination program. EXPERT COMMENTARY Girls-only HPV vaccination may confer a substantial health gain in HPV-related disease prevention. However, vaccine coverage declined remarkably recently possibly related to safety concerns, limiting the benefits from girls' vaccination and increasing the potential additional benefit of sex-neutral HPV vaccination. Considering the emergence of novel vaccination and screening options and the change from cytology- to HPV-based screening in 2017, further research is required to inform decisions on the optimization of an integrated vaccination and screening program.
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Affiliation(s)
- V Qendri
- a Department of Epidemiology and Biostatistics , Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , Netherlands
| | - T M Schurink-Van 't Klooster
- b Center for Infectious Disease Control , National Institute for Public Health and the Environment , Bilthoven , Netherlands
| | - J A Bogaards
- a Department of Epidemiology and Biostatistics , Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , Netherlands.,b Center for Infectious Disease Control , National Institute for Public Health and the Environment , Bilthoven , Netherlands
| | - J Berkhof
- a Department of Epidemiology and Biostatistics , Amsterdam UMC, Vrije Universiteit Amsterdam , Amsterdam , Netherlands
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Kim HW, Kim DH, Kim Y. Men's awareness of cervical cancer: a qualitative study. BMC Womens Health 2018; 18:155. [PMID: 30249228 PMCID: PMC6154413 DOI: 10.1186/s12905-018-0650-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS As HPV is a sexually transmitted virus, men are crucial in the prevention of cervical cancer, but research about men's awareness on cervical cancer is limited. Therefore, in this study, we investigated men's awareness toward women's cervical cancer, to thoroughly understand the viewpoints of men, and to emphasize the centrality of the role of men in the prevention of cervical cancer. METHODS A qualitative descriptive design was chosen to explore men's awareness of women's cervical cancer. Twelve men aged 20-58 were interviewed. Snowball sampling was conducted to recruit participants. RESULTS Most participants stated that they were not interested in women's health, and that they did not have much knowledge about cause and prevention of cervical cancer. They acknowledged that cervical cancer was different from other cancers, based on cause and prognosis of disease. The recognition of cervical cancer in participants varied widely depending on their relationship with women. Respondents' recognition of cervical cancer was classified into four types based on a Situational Awareness (SA) model including individual factors (knowledge about cervical cancer, interest in women's health) and system/task factors (relationship with women, men's responsibility). CONCLUSION This study is one of the few studies describing men's awareness on cervical cancer. Korean men's awareness level was low, and their concern and knowledge were not good. Some participants thought that cervical cancer can be treated, can be prevented, and is recognized as a disease of a female with men intervening. Our participants perceived that the role of men is necessary for the prevention of cervical cancer. Therefore, a strategy is needed to develop the awareness and knowledge of men on cervical cancer prevention. When planning cervical cancer education for men, phase and type-specific approaches are required, depending on perception level.
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Affiliation(s)
- Hae Won Kim
- College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Duck Hee Kim
- Department of Nursing, Woosuk University, 443, Samnye-ro, Samnye-eup, Wanju-gun, Jeollabuk-do 55338 Republic of Korea
| | - Youngji Kim
- College of Nursing, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936 Republic of Korea
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Riesen M, Garcia V, Low N, Althaus CL. Modeling the consequences of regional heterogeneity in human papillomavirus (HPV) vaccination uptake on transmission in Switzerland. Vaccine 2017; 35:7312-7321. [PMID: 29126806 DOI: 10.1016/j.vaccine.2017.10.103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Completed human papillomavirus (HPV) vaccination by age 16 years among women in Switzerland ranges from 17 to 75% across 26 cantons. The consequences of regional heterogeneity in vaccination coverage on transmission and prevalence of HPV-16 are unclear. METHODS We developed a deterministic, population-based model that describes HPV-16 transmission among young adults within and between the 26 cantons of Switzerland. We parameterized the model using sexual behavior data from Switzerland and data from the Swiss National Vaccination Coverage Survey. First, we investigated the general consequences of heterogeneity in vaccination uptake between two sub-populations. We then compared the predicted prevalence of HPV-16 resulting from heterogeneous HPV vaccination uptake in all of Switzerland with homogeneous vaccination at an uptake that is identical to the national average (52%). RESULTS In our baseline scenario, HPV-16 prevalence in women is 3.34% when vaccination is introduced and begins to diverge across cantons, ranging from 0.19 to 1.20% after 15 years of vaccination. After the same time period, overall prevalence of HPV-16 in Switzerland is only marginally higher (0.63%) with heterogeneous vaccination uptake than with homogeneous uptake (0.59%). Assuming inter-cantonal sexual mixing, cantons with low vaccination uptake benefit from a reduction in prevalence at the expense of cantons with high vaccination uptake. CONCLUSIONS Regional variations in uptake diminish the overall effect of vaccination on HPV-16 prevalence in Switzerland, but the effect size is small. Cantonal efforts towards HPV-prevalence reduction by increasing vaccination uptake are impaired by cantons with low vaccination uptake. Although the expected impact on national prevalence would be relatively small, harmonization of cantonal vaccination programs would reduce inter-cantonal differences in HPV-16 prevalence.
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Affiliation(s)
- Maurane Riesen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
| | - Victor Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
| | - Christian L Althaus
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Qendri V, Bogaards JA, Berkhof J. Health and Economic Impact of a Tender-Based, Sex-Neutral Human Papillomavirus 16/18 Vaccination Program in the Netherlands. J Infect Dis 2017; 216:210-219. [PMID: 28586466 DOI: 10.1093/infdis/jix272] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/02/2017] [Indexed: 12/27/2022] Open
Abstract
Background Uptake of human papillomavirus (HPV) vaccine among girls in the Dutch immunization program has plateaued at around 60%. Vaccinating boys may be an appealing complementary strategy for the prevention of HPV-related diseases, especially since tender negotiations and reduced dosing schemes have driven down the cost of vaccination. Methods We expanded a previously published Bayesian synthesis framework to account for all vaccine type-related cancers and herd immunity effects from vaccinating girls and boys. We evaluated the efficiency of vaccinating boys relative to increasing vaccine uptake among girls and assessed the cost-effectiveness of a sex-neutral program. Results Vaccinating 40% of boys along with 60% of girls yielded the same gain in life-years (LYs) as increasing the uptake in girls from 60% to 80%. The incremental cost-effectiveness ratio (ICER) of vaccinating boys was €9134/LY (95% credible interval [CrI], €7323/LY-€11231/LY) under 3% discounting. The ceiling vaccination costs at which the ICER remained below the per capita gross domestic product threshold was €240 (95% CrI, €200-€280) per vaccinated boy. If girls' uptake increased to 90%, the ceiling costs decreased to €70 (95% CrI, €40-€100) per vaccinated boy. Conclusions Vaccinating boys along with girls is only modestly less efficient than increasing uptake among girls and highly likely to be cost-effective under current vaccine costs and uptake in the Netherlands.
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Affiliation(s)
- Venetia Qendri
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
| | - Johannes A Bogaards
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam
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Shapiro GK, Guichon J, Prue G, Perez S, Rosberger Z. A Multiple Streams analysis of the decisions to fund gender-neutral HPV vaccination in Canada. Prev Med 2017; 100:123-131. [PMID: 28435081 DOI: 10.1016/j.ypmed.2017.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 12/25/2022]
Abstract
In Canada, the human papillomavirus (HPV) vaccine is licensed and recommended for females and males. Although all Canadian jurisdictions fund school-based HPV vaccine programs for girls, only six jurisdictions fund school-based HPV vaccination for boys. The research aimed to analyze the factors that underpin government decisions to fund HPV vaccine for boys using a theoretical policy model, Kingdon's Multiple Streams framework. This approach assesses policy development by examining three concurrent, but independent, streams that guide analysis: Problem Stream, Policy Stream, and Politics Stream. Analysis from the Problem Stream highlights that males are affected by HPV-related diseases and are involved in transmitting HPV infection to their sexual partners. Policy Stream analysis makes clear that while the inclusion of males in HPV vaccine programs is suitable, equitable, and acceptable; there is debate regarding cost-effectiveness. Politics Stream analysis identifies the perspectives of six different stakeholder groups and highlights the contribution of government officials at the provincial and territorial level. Kingdon's Multiple Streams framework helps clarify the opportunities and barriers for HPV vaccine policy change. This analysis identified that the interpretation of cost-effectiveness models and advocacy of stakeholders such as citizen-advocates and HPV-affected politicians have been particularly important in galvanizing policy change.
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Affiliation(s)
- Gilla K Shapiro
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada.
| | - Juliet Guichon
- Department of Community Health Sciences, 3280 Hospital Drive, Calgary T2N 4N1, Alberta, Canada
| | - Gillian Prue
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, Northern Ireland, United Kingdom
| | - Samara Perez
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada
| | - Zeev Rosberger
- Department of Psychology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Louise Granofsky Psychosocial Oncology Program, Jewish General Hospital, 4333 Côte St-Catherine Road, Montreal H3T 1E4, Quebec, Canada; Departments of Psychiatry and Oncology, McGill University, 1205 Dr. Penfield Avenue, Montreal H3A 1B1, Quebec, Canada
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Ryser MD, Gravitt PE, Myers ER. Mechanistic mathematical models: An underused platform for HPV research. PAPILLOMAVIRUS RESEARCH 2017; 3:46-49. [PMID: 28720456 PMCID: PMC5518640 DOI: 10.1016/j.pvr.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/20/2017] [Accepted: 01/31/2017] [Indexed: 01/19/2023]
Abstract
Health economic modeling has become an invaluable methodology for the design and evaluation of clinical and public health interventions against the human papillomavirus (HPV) and associated diseases. At the same time, relatively little attention has been paid to a different yet complementary class of models, namely that of mechanistic mathematical models. The primary focus of mechanistic mathematical models is to better understand the intricate biologic mechanisms and dynamics of disease. Inspired by a long and successful history of mechanistic modeling in other biomedical fields, we highlight several areas of HPV research where mechanistic models have the potential to advance the field. We argue that by building quantitative bridges between biologic mechanism and population level data, mechanistic mathematical models provide a unique platform to enable collaborations between experimentalists who collect data at different physical scales of the HPV infection process. Through such collaborations, mechanistic mathematical models can accelerate and enhance the investigation of HPV and related diseases.
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Affiliation(s)
- Marc D Ryser
- Department of Surgery, Division of Advanced Oncologic and GI Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Mathematics, Duke University, Durham, NC, USA.
| | - Patti E Gravitt
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Evan R Myers
- Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
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Brisson M, Bénard É, Drolet M, Bogaards JA, Baussano I, Vänskä S, Jit M, Boily MC, Smith MA, Berkhof J, Canfell K, Chesson HW, Burger EA, Choi YH, De Blasio BF, De Vlas SJ, Guzzetta G, Hontelez JAC, Horn J, Jepsen MR, Kim JJ, Lazzarato F, Matthijsse SM, Mikolajczyk R, Pavelyev A, Pillsbury M, Shafer LA, Tully SP, Turner HC, Usher C, Walsh C. Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models. Lancet Public Health 2016; 1:e8-e17. [PMID: 29253379 PMCID: PMC6727207 DOI: 10.1016/s2468-2667(16)30001-9] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Modelling studies have been widely used to inform human papillomavirus (HPV) vaccination policy decisions; however, many models exist and it is not known whether they produce consistent predictions of population-level effectiveness and herd effects. We did a systematic review and meta-analysis of model predictions of the long-term population-level effectiveness of vaccination against HPV 16, 18, 6, and 11 infection in women and men, to examine the variability in predicted herd effects, incremental benefit of vaccinating boys, and potential for HPV-vaccine-type elimination. METHODS We searched MEDLINE and Embase for transmission-dynamic modelling studies published between Jan 1, 2009, and April 28, 2015, that predicted the population-level impact of vaccination on HPV 6, 11, 16, and 18 infections in high-income countries. We contacted authors to determine whether they were willing to produce new predictions for standardised scenarios. Strategies investigated were girls-only vaccination and girls and boys vaccination at age 12 years. Base-case vaccine characteristics were 100% efficacy and lifetime protection. We did sensitivity analyses by varying vaccination coverage, vaccine efficacy, and duration of protection. For all scenarios we pooled model predictions of relative reductions in HPV prevalence (RRprev) over time after vaccination and summarised results using the median and 10th and 90th percentiles (80% uncertainty intervals [UI]). FINDINGS 16 of 19 eligible models from ten high-income countries provided predictions. Under base-case assumptions, 40% vaccination coverage and girls-only vaccination, the RRprev of HPV 16 among women and men was 0·53 (80% UI 0·46-0·68) and 0·36 (0·28-0·61), respectively, after 70 years. With 80% girls-only vaccination coverage, the RRprev of HPV 16 among women and men was 0·93 (0·90-1·00) and 0·83 (0·75-1·00), respectively. Vaccinating boys in addition to girls increased the RRprev of HPV 16 among women and men by 0·18 (0·13-0·32) and 0·35 (0·27-0·39) for 40% coverage, and 0·07 (0·00-0·10) and 0·16 (0·01-0·25) for 80% coverage, respectively. The RRprev were greater for HPV 6, 11, and 18 than for HPV 16 for all scenarios investigated. Finally at 80% coverage, most models predicted that girls and boys vaccination would eliminate HPV 6, 11, 16, and 18, with a median RRprev of 1·00 for women and men for all four HPV types. Variability in pooled findings was low, but increased with lower vaccination coverage and shorter vaccine protection (from lifetime to 20 years). INTERPRETATION Although HPV models differ in structure, data used for calibration, and settings, our population-level predictions were generally concordant and suggest that strong herd effects are expected from vaccinating girls only, even with coverage as low as 20%. Elimination of HPV 16, 18, 6, and 11 is possible if 80% coverage in girls and boys is reached and if high vaccine efficacy is maintained over time. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
| | - Élodie Bénard
- Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Johannes A Bogaards
- Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, Netherlands
| | - Iacopo Baussano
- Infection and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Simopekka Vänskä
- Vaccination Programme Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Marie-Claude Boily
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Megan A Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia; Lowy Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Harrell W Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily A Burger
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Yoon H Choi
- National Infection Service, Public Health England, London, UK
| | - Birgitte Freiesleben De Blasio
- Oslo Centre for Biostatistics and Epidemiology, Division of Infectious Disease Control, Norwegian Institute of Public Health and Oslo Centre for Statistics and Epidemiology, Oslo, Norway; Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sake J De Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Jan A C Hontelez
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johannes Horn
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Martin R Jepsen
- Section for Geography, Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen, Denmark
| | - Jane J Kim
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Fulvio Lazzarato
- Infection and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France; Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Suzette M Matthijsse
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rafael Mikolajczyk
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | | | - Leigh Anne Shafer
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Stephen P Tully
- Infection and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Hugo C Turner
- Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Cara Usher
- National Centre for Pharmacoeconomics (NCPE Ireland), Dublin, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
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12
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Shapiro GK, Perez S, Rosberger Z. Including males in Canadian human papillomavirus vaccination programs: a policy analysis. CMAJ 2016; 188:881-886. [PMID: 27114488 PMCID: PMC5008935 DOI: 10.1503/cmaj.150451] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Gilla K Shapiro
- Department of Psychology (Shapiro, Perez, Rosberger); Departments of Psychiatry and Oncology (Rosberger), McGill University; Lady Davis Institute for Medical Research (Shapiro, Perez, Rosberger), Jewish General Hospital, Montréal, Que.
| | - Samara Perez
- Department of Psychology (Shapiro, Perez, Rosberger); Departments of Psychiatry and Oncology (Rosberger), McGill University; Lady Davis Institute for Medical Research (Shapiro, Perez, Rosberger), Jewish General Hospital, Montréal, Que
| | - Zeev Rosberger
- Department of Psychology (Shapiro, Perez, Rosberger); Departments of Psychiatry and Oncology (Rosberger), McGill University; Lady Davis Institute for Medical Research (Shapiro, Perez, Rosberger), Jewish General Hospital, Montréal, Que
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Durham DP, Ndeffo-Mbah ML, Skrip LA, Jones FK, Bauch CT, Galvani AP. National- and state-level impact and cost-effectiveness of nonavalent HPV vaccination in the United States. Proc Natl Acad Sci U S A 2016; 113:5107-12. [PMID: 27091978 PMCID: PMC4983834 DOI: 10.1073/pnas.1515528113] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Every year in the United States more than 12,000 women are diagnosed with cervical cancer, a disease principally caused by human papillomavirus (HPV). Bivalent and quadrivalent HPV vaccines protect against 66% of HPV-associated cervical cancers, and a new nonavalent vaccine protects against an additional 15% of cervical cancers. However, vaccination policy varies across states, and migration between states interdependently dilutes state-specific vaccination policies. To quantify the economic and epidemiological impacts of switching to the nonavalent vaccine both for individual states and for the nation as a whole, we developed a model of HPV transmission and cervical cancer incidence that incorporates state-specific demographic dynamics, sexual behavior, and migratory patterns. At the national level, the nonavalent vaccine was shown to be cost-effective compared with the bivalent and quadrivalent vaccines at any coverage despite the greater per-dose cost of the new vaccine. Furthermore, the nonavalent vaccine remains cost-effective with up to an additional 40% coverage of the adolescent population, representing 80% of girls and 62% of boys. We find that expansion of coverage would have the greatest health impact in states with the lowest coverage because of the decreasing marginal returns of herd immunity. Our results show that if policies promoting nonavalent vaccine implementation and expansion of coverage are coordinated across multiple states, all states benefit both in health and in economic terms.
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Affiliation(s)
- David P Durham
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511;
| | - Martial L Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Forrest K Jones
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
| | - Chris T Bauch
- Department of Applied Mathematics, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, Yale University, New Haven, CT 06511
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