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Klein NP, Wiesner A, Bautista O, Group T, Kanu K, Li ZL, McCauley J, Saxena K, Tota J, Luxembourg A, Bonawitz R. Immunogenicity and Safety of Extended-Interval 2-Dose Regimens of 9vHPV Vaccine. Pediatrics 2024; 154:e2023064693. [PMID: 38978512 DOI: 10.1542/peds.2023-064693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Nine-valent human papillomavirus (9vHPV) vaccines can be administered in 2 doses 6 to 12 months apart in adolescents. The impact of extended dose intervals is unknown. We report immunogenicity and safety data in adolescents of a second 9vHPV vaccine dose administered ≥1 year after the first. METHODS This open-label safety and immunogenicity study (NCT04708041) assessed extended-interval 2-dose regimens of 9vHPV vaccine among adolescents (10 to 15 years) who received 2 9vHPV vaccine doses: the first ≥1 year before enrollment, and second, at enrollment (day 1). We measured serologic responses to vaccine-targeted human papillomavirus (HPV) types at enrollment day 1 (pre-dose 2) and 1 month post-dose 2 (month 1) using a competitive LuminexV® immunoassay. We estimated effects of dose interval on geometric mean titers (GMTs) using regression modeling. Participants reported adverse events (AEs) through 15 days after vaccination. RESULTS We enrolled 146 adolescents (mean age 13.3 years) with median 25 months since first 9vHPV vaccine dose (range: 12-53 months). Across vaccine-targeted HPV types, GMTs increased from day 1 to month 1; seropositivity at month 1 was 100%. Anti-HPV GMTs at month 1 were not affected by differences in dose interval of 12 to 53 months, based on regression modeling. The most common AEs were mild-to-moderate injection site reactions; no serious AEs were reported. CONCLUSIONS Extending the interval between first and second 9vHPV vaccine doses to 12 to 53 months did not affect antibody responses, with favorable safety profile. These results support feasibility of extended interval regimens for 9vHPV vaccine.
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Affiliation(s)
- Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
| | - Amy Wiesner
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California
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Bénard É, Drolet M, Laprise JF, Jit M, Prem K, Boily MC, Brisson M. Potential benefit of extended dose schedules of human papillomavirus vaccination in the context of scarce resources and COVID-19 disruptions in low-income and middle-income countries: a mathematical modelling analysis. Lancet Glob Health 2022; 11:e48-e58. [PMID: 36521952 PMCID: PMC9764452 DOI: 10.1016/s2214-109x(22)00475-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/13/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The WHO Strategic Advisory Group of Experts recommended that an extended interval of 3-5 years between the two doses of the human papillomavirus (HPV) vaccine could be considered to alleviate vaccine supply shortages. However, three concerns have limited the introduction of extended schedules: girls could be infected between the two doses, the vaccination coverage for the second dose could be lower at ages 13-14 years than at ages 9-10 years, and identifying girls vaccinated with a first dose to give them the second dose could be difficult. Using mathematical modelling, we examined the potential effect of these concerns on the population-level impact and efficiency of extended dose HPV vaccination schedules. METHODS We used HPV-ADVISE, an individual-based, transmission-dynamic model of multitype HPV infection and disease, calibrated to country-specific data for four low-income and middle-income countries (India, Viet Nam, Uganda, and Nigeria). For the extended dose scenarios, we varied the vaccination coverage of the second dose among girls previously vaccinated, the one-dose vaccine efficacy, and the one-dose vaccine duration of protection. We also examined a strategy in which girls aged 14 years were vaccinated irrespective of their previous vaccination status. We used a scenario of girls-only two-dose vaccination at age 9 years (vaccine=9 valent, vaccine-type efficacy=100%, duration of protection=lifetime, and coverage=80%) as our comparator. We estimated two outcomes: the relative reduction in the age-standardised cervical cancer incidence (population-level impact) and the number of cervical cancers averted per 100 000 doses (efficiency). FINDINGS Our model projected substantial reductions in cervical cancer incidence over 100 years with the two-dose schedule (79-86% depending on the country), compared with no vaccination. Projections for the 5-year extended schedule, in which the second dose is given only to girls previously vaccinated at age 9 years, were similar to the current two-dose schedule, unless vaccination coverage of the second dose is very low (reductions in cervical cancer incidence of 71-78% assuming 30% coverage at age 14 years among girls vaccinated at age 9 years). However, when the dose at age 14 years is given to girls irrespective of vaccination status and assuming high vaccination coverage, the model projected a substantially greater reduction in cervical cancer incidence compared with the current two-dose schedule (reductions in cervical cancer incidence of 86-93% assuming 70% coverage at age 14 years, irrespective of vaccination status). Efficiency of the extended schedule was greater than the two-dose schedule, even with a drop in vaccination coverage. INTERPRETATION The three concerns are unlikely to have a substantial effect on the population-level impact of extended dose schedules. Hence, extended dose schedules will likely provide similar cervical cancer reductions as two-dose schedules, while reducing the number of doses required in the short-term, providing a more efficient use of scarce resources, and offering a 5-year time window to reassess the necessity of the second dose. FUNDING WHO, Canadian Institute of Health Research Foundation, Fonds de recherche du Québec-Santé, Digital Research Alliance of Canada, and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Élodie Bénard
- Département de médecine sociale et préventive, Université Laval, QC, Canada,Centre de recherche du CHU de Québec, Université Laval, QC, Canada
| | - Mélanie Drolet
- Centre de recherche du CHU de Québec, Université Laval, QC, Canada
| | | | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK,School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kiesha Prem
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Marie-Claude Boily
- Département de médecine sociale et préventive, Université Laval, QC, Canada,Centre de recherche du CHU de Québec, Université Laval, QC, Canada,MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Marc Brisson
- Département de médecine sociale et préventive, Université Laval, QC, Canada; Centre de recherche du CHU de Québec, Université Laval, QC, Canada; MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK.
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Ateudjieu J, Sack DA, Nafack SS, Xiao S, Tchio-Nighie KH, Tchokomeni H, Bita’a LB, Nyibio PN, Guenou E, Mondung KM, Dieumo FFK, Ngome RM, Murt KN, Ram M, Ali M, Debes AK. An Age-stratified, Randomized Immunogenicity Trial of Killed Oral Cholera Vaccine with Delayed Second Dose in Cameroon. Am J Trop Med Hyg 2022; 107:974-983. [PMID: 36395746 PMCID: PMC9709001 DOI: 10.4269/ajtmh.22-0462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 11/01/2023] Open
Abstract
The recommended schedule for killed oral cholera vaccine (OCV) is two doses, 2 weeks apart. However, during vaccine campaigns, the second round is often delayed by several months. Because more information is needed to document antibody responses when the second dose is delayed, we conducted an open-label, phase 2, noninferiority clinical trial of OCV. One hundred eighty-six participants were randomized into three dose-interval groups (DIGs) to receive the second dose 2 weeks, 6 months, or 11.5 months after the first dose. The DIGs were stratified into three age strata: 1 to 4, 5 to 14, and > 14 years. Inaba and Ogawa vibriocidal titers were assessed before and after vaccination. The primary analysis was geometric mean titer (GMT) 2 weeks after the second dose. Data for primary analysis was available from 147 participants (54, 44, and 49 participants from the three DIGs respectively). Relative to the 2-week interval, groups receiving a delayed second dose had significantly higher GMTs after the second dose. Two weeks after the second dose, Inaba GMTs were 55.1 190.3, and 289.8 and Ogawa GMTs were 70.4, 134.5, and 302.4 for the three DIGs respectively. The elevated titers were brief, returning to lower levels within 3 months. We conclude that when the second dose of killed oral cholera vaccine was given after 6 or 11.5 months, vibriocidal titers were higher than when given after the standard period of 2 weeks. This provides reassurance that a delayed second dose does not compromise, but rather enhances, the serological response to the vaccine.
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Affiliation(s)
- Jérôme Ateudjieu
- MA Sante, Yaoundé, Cameroon
- Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Cameroon
- Clinical Research Unit, Division of Health Operations Research, Ministry of Public Health, Cameroon
| | - David A Sack
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Shaoming Xiao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | | | | | - Rosanne Minone Ngome
- Department of Bacteriology-Parasitology-Mycology Laboratory, Centre Pasteur of Cameroon (CPC), Yaoundé, Cameroon
| | - Kelsey N. Murt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mohammad Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amanda K. Debes
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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4
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Drolet M, Laprise JF, Martin D, Jit M, Bénard É, Gingras G, Boily MC, Alary M, Baussano I, Hutubessy R, Brisson M. Optimal human papillomavirus vaccination strategies to prevent cervical cancer in low-income and middle-income countries in the context of limited resources: a mathematical modelling analysis. THE LANCET. INFECTIOUS DISEASES 2021; 21:1598-1610. [PMID: 34245682 PMCID: PMC8554391 DOI: 10.1016/s1473-3099(20)30860-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022]
Abstract
Background Introduction of human papillomavirus (HPV) vaccination has been slow in low-income and middle-income countries (LMICs) because of resource constraints and worldwide shortage of vaccine supplies. To help inform WHO recommendations, we modelled various HPV vaccination strategies to examine the optimal use of limited vaccine supplies and best allocation of scarce resources in LMICs in the context of the WHO global call to eliminate cervical cancer as a public health problem. Methods In this mathematical modelling analysis, we developed HPV-ADVISE LMIC, a transmission-dynamic model of HPV infection and diseases calibrated to four LMICs: India, Vietnam, Uganda, and Nigeria. For different vaccination strategies that encompassed use of a nine-valent vaccine (or a two-valent or four-valent vaccine assuming high cross-protection), we estimated three outcomes: reduction in the age-standardised rate of cervical cancer, number of doses needed to prevent one case of cervical cancer (NNV; as a measure of efficiency), and the incremental cost-effectiveness ratio (ICER; in 2017 international $ per disability-adjusted life-year [DALY] averted). We examined different vaccination strategies by varying the ages of routine HPV vaccination and number of age cohorts vaccinated, the population targeted, and the number of doses used. In our base case, we assumed 100% lifetime protection against HPV-16, HPV-18, HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58; vaccination coverage of 80%; and a time horizon of 100 years. For the cost-effectiveness analysis, we used a 3% discount rate. Elimination of cervical cancer was defined as an age-standardised incidence of less than four cases per 100 000 woman-years. Findings We predicted that HPV vaccination could lead to cervical cancer elimination in Vietnam, India, and Nigeria, but not in Uganda. Compared with no vaccination, strategies that involved vaccinating girls aged 9–14 years with two doses were predicted to be the most efficient and cost-effective in all four LMICs. NNV ranged from 78 to 381 and ICER ranged from $28 per DALY averted to $1406 per DALY averted depending on the country. The most efficient and cost-effective strategies were routine vaccination of girls aged 14 years, with or without a later switch to routine vaccination of girls aged 9 years, and routine vaccination of girls aged 9 years with a 5-year extended interval between doses and a catch-up programme at age 14 years. Vaccinating boys (aged 9–14 years) or women aged 18 years or older resulted in substantially higher NNVs and ICERs. Interpretation We identified two strategies that could maximise efforts to prevent cervical cancer in LMICs given constraints on vaccine supplies and costs and that would allow a maximum of LMICs to introduce HPV vaccination. Funding World Health Organization, Canadian Institute of Health Research, Fonds de recherche du Québec–Santé, Compute Canada, PATH, and The Bill & Melinda Gates Foundation. Translations For the French and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | | | - Dave Martin
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Mark Jit
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK; School of Public Health, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Élodie Bénard
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Guillaume Gingras
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Marie-Claude Boily
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec City, QC, Canada
| | | | - Raymond Hutubessy
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marc Brisson
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et preventive, Université Laval, Quebec City, QC, Canada; MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
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5
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Teppler H, Bautista O, Flores S, McCauley J, Luxembourg A. Design of a Phase III immunogenicity and safety study evaluating two-dose regimens of 9-valent human papillomavirus (9vHPV) vaccine with extended dosing intervals. Contemp Clin Trials 2021; 105:106403. [PMID: 33857679 DOI: 10.1016/j.cct.2021.106403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
HPV vaccines are widely licensed as two-dose regimens, 6-12 months apart, for adolescents. Extended intervals between doses may be necessary due to resource constraints or vaccination program disruption. This international, multicenter, open-label study (NCT04708041) will evaluate the safety and immunogenicity of two-dose 9vHPV vaccine regimens with extended intervals of 1-5 years between doses in boys/girls compared with a standard three-dose regimen in women. Participants (planned N = 700) will be enrolled into six cohorts; Cohort 0: boys/girls aged 10-15 years who received one 9vHPV vaccine dose ≥1 year before enrollment without completing the series will receive one study dose of 9vHPV vaccine at day 1; Cohorts 1-4: HPV vaccination-naïve boys/girls aged 9-14 years will receive two doses (day 1 and month 12, 24, 36, or 60); Cohort 5: HPV vaccination-naïve women aged 16-26 years will receive three doses (day 1, months 2 and 6). Primary analyses will be based on serological responses 1 month after final vaccine dose. Co-primary objectives will (1) evaluate non-inferiority of geometric mean titers in each of Cohorts 1-4 versus Cohort 5, and (2) characterize antibody responses in Cohort 0, accounting for the interval between commercial and study vaccine dose. Injection-site and systemic adverse events (AEs) will be collected for 15 days and serious AEs for 12 months post-vaccination; vaccine-related serious AEs and deaths will be collected throughout the study. Results will inform completion of vaccination in individuals who did not complete the recommended series and guide implementation of vaccination programs in resource-limited settings.
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Affiliation(s)
- Hedy Teppler
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Oliver Bautista
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
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- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Sheryl Flores
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Jennifer McCauley
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Alain Luxembourg
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
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Whitworth HS, Schiller J, Markowitz LE, Jit M, Brisson M, Simpson E, Watson-Jones D. Continued HPV vaccination in the face of unexpected challenges: A commentary on the rationale for an extended interval two-dose schedule. Vaccine 2021; 39:871-875. [PMID: 33451778 DOI: 10.1016/j.vaccine.2020.12.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hilary S Whitworth
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - John Schiller
- National Cancer Institute, National Institutes of Health, Maryland, USA
| | - Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Marc Brisson
- Centre de recherche du CHU de Québec and Department of Social and Preventive Medicine, Université Laval, Quebec, QC, Canada
| | - Evan Simpson
- Center for Vaccine Innovation and Access, PATH, Seattle, USA
| | - Deborah Watson-Jones
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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7
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Bornstein J, Roux S, Kjeld Petersen L, Huang LM, Dobson SR, Pitisuttithum P, Diez-Domingo J, Schilling A, Ariffin H, Tytus R, Rupp R, Senders S, Engel E, Ferris D, Kim YJ, Tae Kim Y, Kurugol Z, Bautista O, Nolan KM, Sankaranarayanan S, Saah A, Luxembourg A. Three-Year Follow-up of 2-Dose Versus 3-Dose HPV Vaccine. Pediatrics 2021; 147:peds.2019-4035. [PMID: 33386332 DOI: 10.1542/peds.2019-4035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Human papillomavirus (HPV) antibody responses to the 9-valent human papillomavirus (9vHPV) vaccine among girls and boys (aged 9-14 years) receiving 2-dose regimens (months 0, 6 or 0, 12) were noninferior to a 3-dose regimen (months 0, 2, 6) in young women (aged 16-26 years) 4 weeks after last vaccination in an international, randomized, open-label trial (NCT01984697). We assessed response durability through month 36. METHODS Girls received 2 (months 0 and 6 [0, 6]: n = 301; months 0 and 12 [0, 12]: n = 151) or 3 doses (months 0,2, and 6 [0, 2, 6]: n = 301); boys received 2 doses ([0, 6]: n = 301; [0, 12]: n = 150); and young women received 3 doses ([0, 2, 6]: n = 314) of 9vHPV vaccine. Anti-HPV geometric mean titers (GMTs) were assessed by competitive Luminex immunoassay (cLIA) and immunoglobulin G-Luminex immunoassay (IgG-LIA) through month 36. RESULTS Anti-HPV GMTs were highest 1 month after the last 9vHPV vaccine regimen dose, decreased sharply during the subsequent 12 months, and then decreased more slowly. GMTs 2 to 2.5 years after the last regimen dose in girls and boys given 2 doses were generally similar to or greater than GMTs in young women given 3 doses. Across HPV types, most boys and girls who received 2 doses (cLIA: 81%-100%; IgG-LIA: 91%-100%) and young women who received 3 doses (cLIA: 78%-98%; IgG-LIA: 91%-100%) remained seropositive 2 to 2.5 years after the last regimen dose. CONCLUSIONS Antibody responses persisted through 2 to 2.5 years after the last dose of a 2-dose 9vHPV vaccine regimen in girls and boys. In girls and boys, antibody responses generated by 2 doses administered 6 to 12 months apart may be sufficient to induce high-level protective efficacy through at least 2 years after the second dose.
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Affiliation(s)
- Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Surita Roux
- Synexus Clinical Research SA, Somerset West, Cape Town, South Africa
| | - Lone Kjeld Petersen
- Open Patient Data Explorative Network and Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei City, Taiwan
| | - Simon R Dobson
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Javier Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research of Valencia Region - Public Health, Valencia, Spain
| | - Andrea Schilling
- Department of Obstetrics and Gynecology, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Hany Ariffin
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Richard Tytus
- Hamilton Medical Research Group, Hamilton, Ontario, Canada
| | - Richard Rupp
- The University of Texas Medical Branch, Galveston, Texas
| | | | - Eli Engel
- Bayview Research Group, Valley Village, California
| | - Daron Ferris
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Zafer Kurugol
- Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey; and
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8
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Zimet GD, Osazuwa-Peters N. There's Much Yet to be Done: Diverse Perspectives on HPV Vaccination. Hum Vaccin Immunother 2020; 15:1459-1464. [PMID: 31365327 PMCID: PMC6746479 DOI: 10.1080/21645515.2019.1640559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Gregory D Zimet
- a Department of Pediatrics, School of Medicine, Indiana University , Indianapolis , IN , USA
| | - Nosayaba Osazuwa-Peters
- b Department of Otolaryngology-Head and Neck Surgery, Saint Louis University , St Louis , MO , USA
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9
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Brotherton JM. Rationalizing the HPV vaccination schedule: A long road to a worthwhile destination. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2019; 8:100190. [PMID: 31759174 PMCID: PMC6889720 DOI: 10.1016/j.pvr.2019.100190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Julia Ml Brotherton
- VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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10
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Brotherton JM, Budd A, Rompotis C, Bartlett N, Malloy MJ, Andersen RL, Coulter KA, Couvee PW, Steel N, Ward GH, Saville M. Is one dose of human papillomavirus vaccine as effective as three?: A national cohort analysis. PAPILLOMAVIRUS RESEARCH 2019; 8:100177. [PMID: 31319173 PMCID: PMC6658930 DOI: 10.1016/j.pvr.2019.100177] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/04/2019] [Accepted: 07/13/2019] [Indexed: 01/11/2023]
Abstract
AIM Prophylactic human papillomavirus (HPV) vaccines are highly effective at preventing pre-cancerous cervical lesions when given in a three-dose schedule. Some post-hoc trial data suggest that one dose prevents HPV infection. If one dose could prevent pre-cancerous cervical lesions, then global cervical cancer prevention would be greatly facilitated. We assessed the effectiveness of quadrivalent HPV vaccine by number of doses against cervical intraepithelial neoplasia (CIN) 2 or 3/adenocarcinoma-in-situ (AIS)/cancer in Australia up to seven years post vaccination. METHODS We linked registry data from all 8 jurisdictional cervical screening registers, with the national HPV vaccination register, death index and cancer registers for all Australian women aged 15 or under when eligible for vaccine who screened between April 2007 (when vaccination commenced) and 31 December 2014. We performed Cox proportional hazard regression, adjusted a priori for age, socioeconomic status, and area of residence, to estimate hazard ratios of histologically confirmed CIN2/CIN3/AIS/cancer. RESULTS We included 250,648 women: 48,845 (19·5%) unvaccinated, 174,995 (69·8%) had received three doses, 18,190 (7·3%) two doses and 8,618 (3·4%) one dose. The adjusted hazard ratio was significantly lower for all dose groups compared to unvaccinated women (1 dose 0·65 (95%CI 0·52-0·81), 2 doses 0·61 (0·52-0·72) and 3 doses 0·59 (0·54-0·65).) With adjustment for age at vaccination amongst the vaccinated group, the adjusted hazard ratios for one dose and two dose recipients were comparable to three dose recipients (one dose 1.01 (95%CI 0.81-1.26), two doses 1.00 (0.85-1.17).) Multiple sensitivity analyses, including use of different dose assignment methods, produced consistent findings. Comparison with a historical cohort of age matched women showed that the result was not due to herd protection alone. CONCLUSIONS One dose had comparable effectiveness as two or three doses in preventing high-grade disease in a high coverage setting. These findings support the hypothesis that one dose vaccination may be a viable strategy when working towards the global elimination of cervical cancer.
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Affiliation(s)
- Julia Ml Brotherton
- National HPV Vaccination Program Register, VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
| | - Alison Budd
- Screening Analysis and Monitoring Unit, Australian Institute of Health and Welfare, Canberra, Australia.
| | - Christopher Rompotis
- Screening Analysis and Monitoring Unit, Australian Institute of Health and Welfare, Canberra, Australia.
| | - Natasha Bartlett
- Screening Analysis and Monitoring Unit, Australian Institute of Health and Welfare, Canberra, Australia.
| | - Michael J Malloy
- National HPV Vaccination Program Register, VCS Population Health, VCS Foundation, East Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
| | - Rachael L Andersen
- Screening and Preventive Health Services, Department of Health and Human Services, Melbourne, Victoria, Australia.
| | - Kim Ar Coulter
- Cancer Screening Services, Department of Health, Northern Territory Government, Casuarina, Northern Territory, Australia.
| | - Peter W Couvee
- ACT Cervical Screening Program, Population, Health Protection and Prevention, ACT Health, Canberra, Australian Capital Territory, Australia.
| | - Nerida Steel
- WA Cervical Cancer Prevention Program, Women and Newborn Health Service, North Metropolitan Health Service, Western Australia, Australia; Institute for Health, University of Notre Dame Australia, Fremantle, Western Australia, Australia.
| | - Gail H Ward
- Population Screening and Cancer Prevention, Tasmanian Health Service, Hobart, Tasmania, Australia.
| | - Marion Saville
- VCS Foundation, Carlton, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia.
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