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Schlecht NF, Diaz A, Nucci-Sack A, Shyhalla K, Shankar V, Guillot M, Hollman D, Strickler HD, Burk RD. Incidence and Types of Human Papillomavirus Infections in Adolescent Girls and Young Women Immunized With the Human Papillomavirus Vaccine. JAMA Netw Open 2021; 4:e2121893. [PMID: 34424304 PMCID: PMC8383132 DOI: 10.1001/jamanetworkopen.2021.21893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Rates of human papillomavirus (HPV) infection have decreased since the introduction of HPV vaccines in populations with high vaccine uptake. Data are limited for adolescent and young adult populations in US metropolitan centers. OBJECTIVE To determine HPV infection rates in adolescent girls and young women aged 13 to 21 years in New York City following HPV vaccination. DESIGN, SETTING, AND PARTICIPANTS This cohort study of type-specific cervical HPV detection was conducted at a large adolescent-specific integrated health center in New York City between October 2007 and September 2019. Participants included an open cohort of adolescent girls and young adult women who received the HPV vaccine (Gardasil; Merck & Co) over a 12-year period following HPV vaccination introduction. Data analysis was concluded September 2019. EXPOSURES Calendar date and time since receipt of first vaccine dose. MAIN OUTCOMES AND MEASURES Temporal associations in age-adjusted postvaccine HPV rates. RESULTS A total of 1453 participants, with a mean (SD) age at baseline of 18.2 (1.4) years, were included in the cohort (African American with no Hispanic ethnicity, 515 [35.4%] participants; African American with Hispanic ethnicity, 218 [15.0%] participants; Hispanic with no reported race, 637 [43.8%] participants). Approximately half (694 [47.8%] participants) were vaccinated prior to coitarche. Age-adjusted detection rates for quadrivalent vaccine types (HPV-6, HPV-11, HPV-16, and HPV-18) and related types (HPV-31, and HPV-45) decreased year over year, with the largest effect sizes observed among individuals who had been vaccinated before coitarche (adjusted odds ratio [aOR], 0.81; 95% CI, 0.67-0.98). By contrast, detection was higher year over year for nonvaccine high-risk cervical HPV types (aOR, 1.08; 95% CI, 1.04-1.13) and anal HPV types (aOR, 1.11; 95% CI, 1.05-1.17). The largest effect sizes were observed with nonvaccine types HPV-56 and HPV-68. CONCLUSIONS AND RELEVANCE Whereas lower detection rates of vaccine-related HPV types were observed since introduction of vaccines in female youth in New York City, rates of some nonvaccine high-risk HPV types were higher. Continued monitoring of high-risk HPV prevalence is warranted.
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Affiliation(s)
- Nicolas F. Schlecht
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Angela Diaz
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | - Anne Nucci-Sack
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | - Kathleen Shyhalla
- Department of Cancer Prevention & Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Viswanathan Shankar
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mary Guillot
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | - Dominic Hollman
- Department of Pediatrics, Mount Sinai Adolescent Health Center, Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | - Howard D. Strickler
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Robert D. Burk
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York
- Departments of Pediatrics (Genetics), Microbiology & Immunology and Obstetrics, Gynecology & Women’s Health, Albert Einstein College of Medicine, Bronx, New York
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Latsuzbaia A, Arbyn M, Tapp J, Fischer M, Weyers S, Pesch P, Mossong J. Effectiveness of bivalent and quadrivalent human papillomavirus vaccination in Luxembourg. Cancer Epidemiol 2019; 63:101593. [DOI: 10.1016/j.canep.2019.101593] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/23/2019] [Accepted: 08/28/2019] [Indexed: 01/17/2023]
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Widdice LE, Bernstein DI, Franco EL, Ding L, Brown DR, Ermel AC, Higgins L, Kahn JA. Decline in vaccine-type human papillomavirus prevalence in young men from a Midwest metropolitan area of the United States over the six years after vaccine introduction. Vaccine 2019; 37:6832-6841. [PMID: 31582269 DOI: 10.1016/j.vaccine.2019.08.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to determine changes in human papillomavirus (HPV) prevalence among young men from a Midwest metropolitan area over the six years after vaccine introduction, including HPV prevalence in men overall, in vaccinated men to examine vaccine impact and in unvaccinated men to examine herd protection. An exploratory aim was to examine associations between number of vaccine doses and HPV prevalence. METHODS Men aged 14-26 years reporting male-female and/or male-male sexual contact were recruited from a primary care clinic, sexually transmitted disease clinic, and community setting during two waves of data collection: 2013-2014 (N = 400) and 2016-2017 (N = 347). Participants completed a questionnaire and were tested for penile, scrotal and anal HPV. Changes in prevalence of any (≥1 type) and vaccine-type HPV (HPV6, 11, 16, and/or 18) were examined using propensity score weighted logistic regression. Associations between number of doses and HPV infection were determined using chi-square tests and logistic regression. RESULTS The proportion of men with a history of ≥1 HPV vaccine doses increased from 23% to 44% (p < 0.001) from waves 1 to 2. After propensity score weighting, infection with ≥1 vaccine-type HPV significantly decreased among all men (29% to 20%; 31% decrease; odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.44-0.88) and unvaccinated men (32% to 21%; 36% decrease; OR = 0.56, 95%CI = 0.34-0.86); there was a non-significant decrease (21%) among vaccinated men. Associations between number of doses and HPV prevalence were not statistically significant. CONCLUSIONS Prevalence of vaccine-type HPV decreased among all, vaccinated, and unvaccinated men six years after HPV vaccine recommendation, supporting vaccine impact and herd protection. Decreases in vaccine-type HPV in all men appear to be due to decreases in unvaccinated men, suggesting that the full impact of vaccination has yet to be realized. Continued monitoring and efforts to vaccinate men prior to sexual initiation are warranted.
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Affiliation(s)
- Lea E Widdice
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - David I Bernstein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - Eduardo L Franco
- Department of Oncology and Department of Epidemiology & Biostatistics, McGill University, Faculty of Medicine, 5100 Maisonneuve Blvd West, Suite 720, Montreal, QC H4A3T2, Canada.
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - Darron R Brown
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, 635 Barnhill Dr., Van Nuys Medical Sciences Building, Suite 224, Indianapolis, IN 46202, USA.
| | - Aaron C Ermel
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, 635 Barnhill Dr., Van Nuys Medical Sciences Building, Suite 224, Indianapolis, IN 46202, USA.
| | - Lisa Higgins
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
| | - Jessica A Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, USA.
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Machalek DA, Garland SM, Brotherton JML, Bateson D, McNamee K, Stewart M, Rachel Skinner S, Liu B, Cornall AM, Kaldor JM, Tabrizi SN. Very Low Prevalence of Vaccine Human Papillomavirus Types Among 18- to 35-Year Old Australian Women 9 Years Following Implementation of Vaccination. J Infect Dis 2019; 217:1590-1600. [PMID: 29425358 DOI: 10.1093/infdis/jiy075] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/06/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction A quadrivalent human papillomavirus vaccination program targeting females aged 12-13 years commenced in Australia in 2007, with catch-up vaccination of 14-26 year olds through 2009. We evaluated the program's impact on HPV prevalence among women aged 18-35 in 2015. Methods HPV prevalence among women aged 18-24 and 25-35 was compared with prevalence in these age groups in 2005-2007. For women aged 18-24, we also compared prevalence with that in a postvaccine study conducted in 2010-2012. Results For the 2015 sample, Vaccination Register-confirmed 3-dose coverage was 53.3% (65.0% and 40.3% aged 18-24 and 25-35, respectively). Prevalence of vaccine HPV types decreased from 22.7% (2005-2007) and 7.3% (2010-2012), to 1.5% (2015) (P trend < .001) among women aged 18-24, and from 11.8% (2005-2007) to 1.1% (2015) (P = .001) among those aged 25-35. Conclusions This study, reporting the longest surveillance follow-up to date, shows prevalence of vaccine-targeted HPV types has continued to decline among young women. A substantial fall also occurred in women aged 25-35, despite lower coverage. Strong herd protection and effectiveness of less than 3 vaccine doses likely contributed to these reductions.
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Affiliation(s)
- Dorothy A Machalek
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,School of Population and Global Health, University of Melbourne, Victoria
| | - Suzanne M Garland
- Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - Julia M L Brotherton
- School of Population and Global Health, University of Melbourne, Victoria.,National HPV Vaccination Program Register, Victorian Cytology Service, East Melbourne, Victoria
| | - Deborah Bateson
- Family Planning New South Wales, Sydney.,Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney
| | - Kathleen McNamee
- Family Planning Victoria, Melbourne.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria
| | | | - S Rachel Skinner
- Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead
| | - Bette Liu
- School of Public Health and Community Medicine
| | - Alyssa M Cornall
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
| | - John M Kaldor
- The Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia
| | - Sepehr N Tabrizi
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Melbourne.,Murdoch Children's Research Institute, Melbourne, Victoria.,Department of Obstetrics and Gynaecology, University of Melbourne, Victoria
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Ährlund-Richter A, Cheng L, Hu YOO, Svensson M, Pennhag AAL, Ursu RG, Haeggblom L, Grün N, Ramqvist T, Engstrand L, Dalianis T, Du J. Changes in Cervical Human Papillomavirus (HPV) Prevalence at a Youth Clinic in Stockholm, Sweden, a Decade After the Introduction of the HPV Vaccine. Front Cell Infect Microbiol 2019; 9:59. [PMID: 30949454 PMCID: PMC6435486 DOI: 10.3389/fcimb.2019.00059] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 12/21/2022] Open
Abstract
Aim: This study aimed to follow the impact of human papillomavirus (HPV) catch-up and vaccination on the very high cervical HPV-prevalence in women at a youth clinic in central Stockholm during the period 2008–2018. Background: 2008–2010, cervical HPV-prevalence (69.5%) and HPV16 prevalence (34.7%) were high in non-vaccinated women at a youth clinic in Stockholm. 2013–2015, after the introduction of the quadrivalent-Gardasil® HPV-vaccine, HPV16 and HPV6 prevalence had decreased. Here, cervical HPV-prevalence was investigated 10 years after primary sampling. Material and Methods: 2017–2018, 178 cervical swabs, from women aged 15–23 years old, were tested for 27 HPV types by a bead-based multiplex method. HPV-prevalence data were then related to vaccination status and age and compared to HPV-prevalence in 615 samples from 2008 to 2010 and 338 samples from 2013 to 2015 from the same clinic, and to HPV types in 143 cervical cancer cases during 2003–2008 in Stockholm. Results: The proportion of vaccinated women increased from 10.7% (2008–2010) to 82.1% (2017–2018). The prevalence of all 27 HPVs, all high-risk HPVs (HR-HPVs) and the combined presence of the quadrivalent-Gardasil® types HPV16, 18, 6, and 11, was lower in vaccinated compared to unvaccinated women (67.4 vs. 93.3%, p = 0.0031, 60.1 vs. 86.7%, p = 0.0057 and 5.8 vs. 26.7%, p = 0.002, respectively). Furthermore, HPV16 prevalence in non-vaccinated women 2017–2018 was lower than that in 2008–2010 (16.7 and 34.7%, respectively, p = 0.0471) and similar trends were observed for HPV18 and 11. In both vaccinated and non-vaccinated women, the most common non-quadrivalent-Gardasil® vaccine HR-HPV types were HPV39, 51, 52, 56, and 59. Together they accounted for around 9.8% of cervical cancer cases in Stockholm during 2003–2008, and their prevalence tended to have increased during 2017–2018 compared to 2008–2010. Conclusion: Quadrivalent-Gardasil® vaccination has decreased HPV-vaccine type prevalence significantly. However, non-vaccine HR-HPV types remain high in potentially high-risk women at a youth clinic in Stockholm.
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Affiliation(s)
| | - Liqin Cheng
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden
| | - Yue O O Hu
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Mikaela Svensson
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden
| | - Alexandra A L Pennhag
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Ramona G Ursu
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Microbiology (Bacteriology, Virology) and Parasitology, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Linnea Haeggblom
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Nathalie Grün
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Ramqvist
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Engstrand
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden.,Science for Life Laboratory, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Juan Du
- Department of Microbiology, Tumor and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Stockholm, Sweden
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Spinner C, Ding L, Bernstein DI, Brown DR, Franco EL, Covert C, Kahn JA. Human Papillomavirus Vaccine Effectiveness and Herd Protection in Young Women. Pediatrics 2019; 143:peds.2018-1902. [PMID: 30670582 PMCID: PMC6361347 DOI: 10.1542/peds.2018-1902] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Clinical trials of the 4-valent human papillomavirus (HPV) vaccine demonstrate high efficacy, but surveillance studies are essential to examine the long-term impact of vaccine introduction on HPV prevalence in community settings. The aims of this study were to determine during the 11 years after vaccine introduction the prevalence of (1) vaccine-type HPV in adolescent and young adult women who were vaccinated (to assess vaccine effectiveness) and (2) vaccine-type HPV in women who were unvaccinated (to assess herd protection). METHODS Young women 13 to 26 years of age were recruited from hospital-based and community health clinics for 4 surveillance studies from 2006 to 2017. We determined the proportion of vaccinated and unvaccinated women who were positive for vaccine-type HPV across the studies, and the odds of positivity for vaccine-type HPV using logistic regression; all analyses were propensity score-adjusted to control for between-wave differences in participant characteristics. RESULTS Vaccination rates increased from 0% to 84.3% (97% of study participants received the 4-valent vaccine). Among women who were vaccinated, 4-valent vaccine-type HPV detection decreased from 35% to 6.7% (80.9% decline; odds ratio 0.13, 95% confidence interval 0.08 to 0.22). Among women who were unvaccinated, 4-valent vaccine-type HPV detection decreased from 32.4% to 19.4% (40% decline; odds ratio 0.50, 95% confidence interval 0.26 to 0.97). Estimated vaccine effectiveness was 90.6% in wave 3 and 80.1% in wave 4. CONCLUSIONS In this study in which trends in HPV in a US community >10 years after 4-valent HPV vaccine introduction and after 9-valent vaccine introduction were examined, we found evidence of vaccine effectiveness and herd protection. Further research is needed to examine trends in 9-valent vaccine-type HPV after higher rates of vaccination are achieved.
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Affiliation(s)
| | - Lili Ding
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - David I. Bernstein
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Courtney Covert
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jessica A. Kahn
- College of Medicine, Cincinnati, Ohio;,Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Šterbenc A, Maver Vodičar P, Poljak M. Recent advances in prophylactic human papillomavirus (HPV) vaccination: a review of key literature published between September 2017 and September 2018. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018. [DOI: 10.15570/actaapa.2018.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Donken R, Ogilvie GS, Bettinger JA, Sadarangani M, Goldman RD. Effect of human papillomavirus vaccination on sexual behaviour among young females. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:509-513. [PMID: 30002026 PMCID: PMC6042675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Question At the time of implementation of human papillomavirus (HPV) vaccine immunization programs, concerns were raised by parents, clinicians, and public health professionals about HPV vaccination possibly leading to riskier sexual health choices among young females. If HPV vaccination influences sexual behaviour among vaccinated females, this might influence the effect of HPV vaccination programs. What is known about the effects of the HPV vaccination program on sexual behaviour among young females?Answer Human papillomavirus vaccination has not been associated with increased sexual risk behaviour among young females. However, currently available studies have some important limitations, and future studies should focus on a longitudinal design that includes a prevaccination baseline measurement, adjustment for possible confounders, and measurement of both clinical indicators and behavioural outcomes.
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