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Kohler RE, Wagner RB, Careaga K, Btoush R, Greene K, Kantor L. Mothers' perceptions and attitudes about HPV vaccination initiation among 9- and 10-year-olds. Hum Vaccin Immunother 2023; 19:2270842. [PMID: 37955127 PMCID: PMC10653617 DOI: 10.1080/21645515.2023.2270842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
HPV vaccination has potential to prevent 90% of HPV-associated cancers. The Advisory Committee on Immunization Practices recommends HPV vaccination for 11- and 12-year-olds, but vaccine initiation can start at age 9. The purpose of this study was to explore perceptions about starting HPV vaccination at a younger age to inform future interventions that promote initiation at ages 9 and 10 years. This was part of a larger study about vaccine hesitancy among racially/ethnically diverse parents of adolescents in the Greater Newark Area of New Jersey. We thematically analyzed transcripts from 16 interviews with English- and Spanish-speaking mothers who had at least one child ≤ 10 years. Analyses focused on perceptions of HPV-related disease risk, attitudes toward HPV vaccination need, and vaccine confidence specifically for 9- and 10-year-olds. Few parents with young adolescents reported receiving vaccination recommendations, and only one reported series initiation before age 11. Mothers' hesitation about younger HPV vaccination initiation revolved around: 1) low perceived necessity among English-speaking mothers due to young adolescents not being sexually active, 2) concerns about potential side effects associated with vaccinating prepubescent adolescents, and 3) a desire for adolescents to be old enough to provide assent. Participants were not opposed to younger initiation but wanted and relied on pediatricians to inform them about vaccination for younger adolescents. These findings suggest mothers are willing to vaccinate at younger ages after clear provider recommendations. Equipping providers with evidence about vaccine safety and cancer prevention communication strategies may promote initiation and timely completion at younger ages.
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Affiliation(s)
- Racquel E. Kohler
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Rachel B. Wagner
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
| | - Katherine Careaga
- Center for Cancer Health Equity, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Rula Btoush
- School of Nursing, Rutgers University, New Brunswick, NJ, USA
| | - Kathryn Greene
- School of Communication & Information, Rutgers University, New Brunswick, NJ, USA
| | - Leslie Kantor
- School of Public Health, Rutgers University, New Brunswick, NJ, USA
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Checchi M, Mesher D, Panwar K, Anderson A, Beddows S, Soldan K. The impact of over ten years of HPV vaccination in England: Surveillance of type-specific HPV in young sexually active females. Vaccine 2023; 41:6734-6744. [PMID: 37821315 DOI: 10.1016/j.vaccine.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The UK national human papillomavirus (HPV) vaccination programme was introduced in 2008 using the bivalent HPV16/18 vaccine, changing to the quadrivalent HPV6/11/16/18 vaccine from 2012. We provide an analysis of type-specific HPV prevalence in young sexually active females in England to end 2020 (when the first routinely HPV vaccinated females were reaching 25 years of age and entering the National Health Service Cervical Screening Programme), showing the impact of over ten years of high coverage HPV vaccination. METHODS Residual vulvovaginal swabs (VVS) were collected from 16 to 24 year old women attending for chlamydia screening between 2010 and 2020, anonymised and tested for type-specific HPV DNA. Trends in vaccine and non-vaccine HPV type prevalence were compared over time and association with vaccination coverage was evaluated within the post-vaccination period. RESULTS A total of 21,168 eligible VVS specimens were tested for HPV DNA. The prevalence of HPV16/18 in sexually active 16-18 year old females who were offered vaccination aged 12-13 years was <1% in the most recent years tested, compared to over 15% prior to the vaccination programme in 2008. The magnitude of these decreases also suggests reduced transmission is offering some herd protection to unvaccinated females. HPV31/33/45 prevalence also steadily decreased, providing evidence of cross-protection. HPV6/11 prevalence remained stable during the bivalent vaccine period, with more recent declines, as expected due to the use of the quadrivalent vaccine. There has been no substantive increase in the prevalence of other high-risk (HR) HPV types. DISCUSSION More than ten years of high coverage HPV vaccination in adolescent females in England has delivered dramatic declines in the prevalence of HPV vaccine-types and closely related HPV types in females in the vaccine eligible age group, and no indication of type replacement. These findings should enable confidence in planning for cervical screening of these females, and in predicting declines in HPV-related cancers.
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Affiliation(s)
- Marta Checchi
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK.
| | - David Mesher
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Kavita Panwar
- Virus Reference Department, UK Health Security Agency, London, UK
| | - Anja Anderson
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
| | - Simon Beddows
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK; Virus Reference Department, UK Health Security Agency, London, UK
| | - Kate Soldan
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, UK Health Security Agency, London, UK
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Ahmed MY, Salman NA, Sandhu S, Cakir MO, Seddon AM, Kuehne C, Ashrafi GH. Detection of high-risk Human Papillomavirus in prostate cancer from a UK based population. Sci Rep 2023; 13:7633. [PMID: 37165210 PMCID: PMC10172334 DOI: 10.1038/s41598-023-34734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/06/2023] [Indexed: 05/12/2023] Open
Abstract
Human papillomavirus (HPV) infection is one of the sexually transmitted diseases which have been implicated in the etiology of multiple cancers. To date, several studies have been conducted to evaluate the incidence of high-risk (HR) HPV in prostate cancer (PCa) which have generated widely conflicting data. Hence, this leaves a lack of awareness on the causal role of persistent HPV infection in the development of PCa. Although this has been investigated in a handful of countries, to the best of our knowledge, no prior studies have been conducted in the UK. In this study, polymerase chain reaction (PCR) and Sanger sequencing were implemented to analyze a total of 49 fresh prostate specimens (35 benign and 14 malignant specimens) for the presence of viral DNA of 12 HR-HPV types. Data obtained confirmed the presence of HR-HPV in 32.7% of analyzed benign and malignant prostate tissues with HPV 35 being identified as the most frequent type. Moreover, HR-HPV positivity rate was found to be higher in abnormal prostate tissues (adenocarcinoma and benign with prostatitis) compared those with normal prostate condition. Using immunohistochemistry, we have confirmed the expression of HPV E7 protein in prostate tissues positive for HPV DNA. This observation, the first reported from a UK population, suggests that the presence of HPV in prostate tissue is likely to be a related factor in the progression of certain cases of prostate cancer.
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Affiliation(s)
- M Yahya Ahmed
- School of Life Science, Pharmacy and Chemistry, Kingston University London, London, KT1 2EE, UK
| | - Nadia Aziz Salman
- School of Life Science, Pharmacy and Chemistry, Kingston University London, London, KT1 2EE, UK
| | - Sarbjinder Sandhu
- Department of Urology and Surgery, Kingston Hospital, Kingston upon Thames, London, KT2 7QB, UK
| | - M Okan Cakir
- School of Life Science, Pharmacy and Chemistry, Kingston University London, London, KT1 2EE, UK
| | - Alan M Seddon
- School of Life Science, Pharmacy and Chemistry, Kingston University London, London, KT1 2EE, UK
| | - Christian Kuehne
- CEO Valdospan GmbH, Technopark 1D, 3430, Tulln an der Donau, Austria
| | - G Hossein Ashrafi
- School of Life Science, Pharmacy and Chemistry, Kingston University London, London, KT1 2EE, UK.
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Chen L, Huang L, Dong B, Gu Y, Cang W, Li C, Sun P, Xiang Y. ADCY7 mRNA Is a Novel Biomarker in HPV Infection and Cervical High-Grade Squamous Lesions or Higher. Biomedicines 2023; 11:biomedicines11030868. [PMID: 36979847 PMCID: PMC10045083 DOI: 10.3390/biomedicines11030868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
The effect of cervical cancer immunotherapy is limited. Combination therapy will be a new direction for cervical cancer. Thus, it is essential to discover a novel and available predictive biomarker to stratify patients who may benefit from immunotherapy for cervical cancer. In this study, 563 participants were enrolled. Adenylate cyclase 7 (ADCY7) mRNA was detected by real-time quantitative PCR (qPCR) with cervical cytology specimens. The relationship between ADCY7 and cervical intraepithelial neoplasia in grade 2 and higher (CIN2+) was analyzed, and the optimal cut-off values of the relative expression of ADCY7 mRNA to predict CIN2+ were calculated. In addition, the clinical significance of ADCY7 in cervical cancer was determined by the Kaplan–Meier Cox regression based on the TCGA database. The mean ADCY7 mRNA expression increased significantly with cervical lesion development, especially compared with CIN2+ (p < 0.05). Moreover, the expression of ADCY7 increased significantly in high-risk human papillomavirus (HR-HPV) infection but not in HPV-A5/6 species. The area under the receiver operating characteristic curve (AUC) of ADCY7 was 0.897, and an optimal cut-off was 0.435. Furthermore, ADCY7 had the highest OR (OR= 8.589; 95% CI (2.281–22.339)) for detecting CIN 2+, followed by HPV genotyping, TCT, and age (OR = 4.487, OR = 2.071, and OR = 1.345; 95% CI (1.156–10.518), (0.370–8.137), and (0.171–4.694), respectively). Moreover, this study indicated that higher ADCY7 levels could be a suitable predictor for poor prognosis in cervical cancer due to immune cell infiltration. A new auxiliary predictor of CIN2+ in cervical cytology specimens is ADCY7 ≥ 0.435. Furthermore, it may be a promising prognosis predictor and potential immunotherapy target for the combined treatment of cervical cancer and possibly further block HR-HPV persistent infection.
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Affiliation(s)
- Lihua Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China
| | - Lixiang Huang
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China
| | - Binhua Dong
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China
- Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital (Fujian Women and Children’s Hospital), Fuzhou 350001, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital (Fujian Obstetrics and Gynecology Hospital), Fuzhou 350001, China
| | - Yu Gu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China
| | - Wei Cang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China
| | - Chen Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, China
- Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital (Fujian Women and Children’s Hospital), Fuzhou 350001, China
- Fujian Clinical Research Center for Gynecological Oncology, Fujian Maternity and Child Health Hospital (Fujian Obstetrics and Gynecology Hospital), Fuzhou 350001, China
- Correspondence: (P.S.); (Y.X.); Tel.: +86-591-87558732 (P.S.); +86-01065296068 (Y.X.); Fax: +86-591-87551247 (P.S.); +86-01065296218 (Y.X.)
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China
- National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China
- Correspondence: (P.S.); (Y.X.); Tel.: +86-591-87558732 (P.S.); +86-01065296068 (Y.X.); Fax: +86-591-87551247 (P.S.); +86-01065296218 (Y.X.)
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Rebolj M, Mathews CS, Denton K. Cytology interpretation after a change to HPV testing in primary cervical screening: Observational study from the English pilot. Cancer Cytopathol 2022; 130:531-541. [PMID: 35377967 PMCID: PMC9542289 DOI: 10.1002/cncy.22572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Overcalling of abnormalities has been a concern for using cytology triage after positive high-risk human papillomavirus (HPV) tests in cervical screening. METHODS The authors studied the detection of cytological and histological abnormalities at age 24 to 64 years, using data from the English HPV pilot. The pilot compared routine implementation of primary cervical screening based on cytology (N = 931,539), where HPV test results were not available before cytology reporting, with that based on HPV testing (N = 403,269), where cytology was only required after positive HPV tests. RESULTS Revealed HPV positivity was associated with a higher direct referral to colposcopy after any abnormality (adjusted odds ratio [ORadj ], 1.16; 95% confidence interval [CI], 1.14-1.18). Laboratories with higher direct referral referred fewer persistently HPV-positive women after early recall. The detection of high-grade cervical intraepithelial neoplasia (CIN2+) after direct referral increased with an ORadj of 1.17 (95% CI, 1.13-1.20) for informed versus uninformed cytology. Generally, the positive predictive value (PPV) of colposcopy for CIN2+ remained comparable under both conditions of interpreting cytology. In women 50 to 64 years old with high-grade dyskaryosis, however, the PPV increased from 71% to 83% after revealing HPV positivity (ORadj , 2.05; 95% CI, 1.43-2.93). CONCLUSIONS Quality-controlled cervical screening programs can avoid inappropriate overgrading of HPV-positive cytology.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention GroupSchool of Cancer and Pharmaceutical SciencesFaculty of Life Sciences and MedicineKing's College LondonLondonUnited Kingdom
| | - Christopher S. Mathews
- Cancer Prevention GroupSchool of Cancer and Pharmaceutical SciencesFaculty of Life Sciences and MedicineKing's College LondonLondonUnited Kingdom
| | - Karin Denton
- Severn PathologySouthmead HospitalNorth Bristol NHS TrustBristolUnited Kingdom
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Rebolj M, Mathews CS, Pesola F, Cuschieri K, Denton K, Kitchener H. Age-specific outcomes from the first round of HPV screening in unvaccinated women: Observational study from the English cervical screening pilot. BJOG 2022; 129:1278-1288. [PMID: 34913243 DOI: 10.1111/1471-0528.17058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report detailed age-specific outcomes from the first round of an English pilot studying the implementation of high-risk human papillomavirus (HR-HPV) testing in primary cervical screening. DESIGN Observational study with screening in 2013-2016, followed by two early recalls and/or colposcopy until the end of 2019. SETTING Six NHS laboratory sites. POPULATION A total of 1 341 584 women undergoing screening with HR-HPV testing or liquid-based cytology (LBC). METHODS Early recall tests and colposcopies were recommended, depending on the nature of the screening-detected abnormality. MAIN OUTCOME MEASURES We reported standard screening process indicators, e.g. proportions with an abnormality, including high-grade cervical intraepithelial neoplasia (CIN2+) or cancer, and the positive predictive value (PPV) of colposcopy for CIN2+, by screening test and age group. RESULTS Among unvaccinated women screened with HR-HPV testing at age 24-29 years, 26.9% had a positive test and 10.4% were directly referred to colposcopy following cytology triage, with a PPV for CIN2+ of 47%. At 50-64 years of age, these proportions were much lower: 5.3%, 1.2% and 27%, respectively. The proportions of women testing positive for HR-HPV without cytological abnormalities, whose early recall HR-HPV tests returned negative results, were similar across the age spans: 54% at 24-29 years and 55% at 50-64 years. Two-thirds of infections at any age were linked to non-16/18 genotypes. Among women with CIN2, CIN3 or cervical cancer, however, the proportion of non-16/18 infections increased with age. As expected, the detection of abnormalities was lower following screening with LBC. CONCLUSIONS These data provide a reliable reference for future epidemiological studies, including those concerning the effectiveness of HPV vaccination. TWEETABLE ABSTRACT Data from the English pilot study provide a comprehensive overview of abnormalities detected through HPV screening.
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Affiliation(s)
- Matejka Rebolj
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Christopher S Mathews
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Francesca Pesola
- Cancer Prevention Group, School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Kate Cuschieri
- Scottish HPV Reference Laboratory, Royal Infirmary of Edinburgh, NHS Lothian Scotland, Edinburgh, UK
| | - Karin Denton
- Severn Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Henry Kitchener
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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Combita AL, Reyes V, Puerto D, Murillo R, Sánchez R, Nuñez M, Hernandez-Suarez GA, Wiesner C. Reduction in Vaccine HPV Type Infections in a Young Women Group (18-25 Years) Five Years after HPV Vaccine Introduction in Colombia. Cancer Prev Res (Phila) 2022; 15:55-66. [PMID: 34610993 PMCID: PMC9662904 DOI: 10.1158/1940-6207.capr-21-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/29/2021] [Accepted: 09/21/2021] [Indexed: 01/07/2023]
Abstract
In Colombia, the human papillomavirus (HPV) vaccine was launched in 2012 in the context of a school-based national vaccination program targeting girls ages 9 to 14 and offering catch-up vaccination for girls ages 14 to 17. In this study, we evaluated the program's impact on type-specific HPV infection by comparing HPV cervical prevalence among vaccinated and nonvaccinated women. This is a comparative cross-sectional study conducted 5 years after the quadrivalent HPV vaccination implementation in a sentinel Colombian City. This study included young women (18-25 years old) who had been vaccinated in the catch-up group and were attending universities and technical institutions, and women who attended primary health care facilities for Pap smear screening. The HPV prevalence of 1,287 unvaccinated women was compared with the prevalence of 1,986 vaccinated women. The prevalence of HPV16/18 infections was significantly lower in vaccinated compared with unvaccinated women (6.5% vs. 15.4%; P < 0.001), whereas for HPV6/11 infections, a decrease of 63.7% in vaccinated women (1.02% vs. 2.81%) was observed. The adjusted effectiveness to HPV16/18 was 61.4%; 95% CI, 54.3%-67.6%. However, the effectiveness against HPV16/18 was significantly higher among women vaccinated before their sexual debut 91.5%; 95% CI, 86.8-94.5, compared with effectiveness for vaccination after their sexual debut, 36.2%; 95% CI, 23.6-46.7. Five years after the introduction of HPV vaccines in Colombia, high effectiveness of HPV to prevent HPV16/18 infections is observed in the catch-up cohorts including virgin and sexually active women. PREVENTION RELEVANCE: Monitoring HPV vaccines post-licensure plays an important role in assessing the progress of immunization programs, demonstrating the impact of vaccines on the population, and providing data for policy needs. In Colombia, HPV vaccines showed effectiveness when administered before start of sexual activity, and two doses are sufficient to achieve good protection.
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Affiliation(s)
- Alba L. Combita
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia.,Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.,Corresponding Author: Alba L. Combita, Cancer Biology Research Group, National Cancer Institute of Colombia (INC), Calle 1 #9-85, Bogotá 111511, Colombia. Phone: 571-4320160, ext. 4212; Fax: 571-3341360; E-mail:
| | - Viviana Reyes
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología (INC), Bogotá, Colombia
| | - Devi Puerto
- Grupo de Investigación en Salud Pública y Epidemiología, INC, Bogotá, Colombia
| | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Marcela Nuñez
- GASPI. Grupo Apoyo y Seguimiento para la Investigación, INC, Bogotá, Colombia
| | | | - Carolina Wiesner
- Grupo de Investigación en Salud Pública y Epidemiología, INC, Bogotá, Colombia
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Litwin C, Smith L, Donken R, Krajden M, van Niekerk D, Naus M, Cook D, Albert A, Ogilvie G. High-risk HPV prevalence among women undergoing cervical cancer screening: Findings a decade after HPV vaccine implementation in British Columbia, Canada. Vaccine 2021; 39:5198-5204. [PMID: 34344555 DOI: 10.1016/j.vaccine.2021.07.009] [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: 03/24/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND British Columbia (BC) introduced a publicly funded, school-based human papillomavirus (HPV) immunization program in 2008 with the quadrivalent vaccine. In 2010/2011, a baseline evaluation of HPV prevalence was conducted among women undergoing cervical cancer screening. After 10 years of publicly funded HPV vaccination, HPV-type prevalence was re-evaluated. METHODS From August 2017 to March 2018, 1107 physicians were invited to return cytobrushes used during routine Pap screening to the Cervical Cancer Screening Laboratory for HPV testing. Only age or year of birth was collected. Specimens were screened for high-risk HPV (hrHPV) and positive samples were genotyped. HPV type prevalence was compared for females 15-22 yrs (those eligible for the school-based vaccination) and 23+ yrs (ineligible for school-based vaccination) for the 2010/2011 and the 2017/2018 data. RESULTS There were 3309 valid samples received for testing; of these, 3107 were included in the analysis. The overall hrHPV prevalence was 12.2% (95% CI 11.3-13.3) in 2010/11, and 12.0% (95% CI 10.9-13.2) in 2017/18. For the 15-22 age group, the prevalence for any hrHPV was 26.8% (95% CI 23.1-30.8) in 2010/11 and 25.4% (95% CI 15.3-37.9) in 2017/18. For those aged 15-22, HPV16 prevalence in 2010/11 was 8.8% (95% CI 6.5-11.5) and in 2017/18 was 6.3% (95% CI 1.8-15.5), with corresponding figures for HPV18 3.7% (95% CI 2.3-5.7) and 0% (95% CI 0.0-5.7), respectively. For all hrHPV types, there were no statistically significant differences between the 2010/11 and 2017/18 periods. CONCLUSIONS This study illustrates the prevalence of hrHPV in BC over time in women undergoing cervical cancer screening, where an indication of a decline in HPV16/18 is seen in vaccine eligible women.
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Affiliation(s)
- Charles Litwin
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada.
| | - Laurie Smith
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; BC Cancer, Vancouver, British Columbia, Canada
| | - Robine Donken
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada; Vaccine Evaluation Centre, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada; Amsterdam UMC, Vrije Universiteit, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Mel Krajden
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Cancer, Vancouver, British Columbia, Canada
| | - Monika Naus
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
| | - Gina Ogilvie
- University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada; Women's Health Research Institute, BC Women's Hospital and Health Service, Vancouver, British Columbia, Canada
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Sabeena S, Ravishankar N. Postvaccination prevalence of vaccine-Human Papillomavirus (vHPV) genotypes among the target population: A systematic review and meta-analysis. J Med Virol 2021; 93:4659-4667. [PMID: 33764530 DOI: 10.1002/jmv.26968] [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: 10/23/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 11/07/2022]
Abstract
Human Papillomavirus (HPV) vaccines are safe and are highly effective in reducing the prevalence of HPV infections and subsequent HPV associated diseases in the target population. A systematic review and meta-analysis was carried out searching electronic databases for articles published between January 2007 and September 2020 reporting the prevalence estimates of vaccine HPV (vHPV) types in women who had received one or more doses of quadrivalent or bivalent vaccines. This systematic review was based on standard systematic review guidelines and the meta-analysis was performed by pooling the HPV vaccine type prevalence data with 95% confidence interval (CI) among 16,929 young women who had received the prophylactic HPV vaccines before the age of 27 years. The overall pooled prevalence of vHPV types was.0.04 (95% CI: 0.02, 0.05). The meta-analysis concludes that prophylactic HPV vaccination before the age of 27 years results in a decline of vHPV types in young women.
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Affiliation(s)
- Sasidharanpillai Sabeena
- Manipal Institute of Virology, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Nagaraja Ravishankar
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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10
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Systematic literature review of cross-protective effect of HPV vaccines based on data from randomized clinical trials and real-world evidence. Vaccine 2021; 39:2224-2236. [PMID: 33744051 DOI: 10.1016/j.vaccine.2020.11.076] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The extent of cross-protection provided by currently licensed bivalent and quadrivalent HPV vaccines versus direct protection against HPV 31-, 33-, 45-, 52-, and 58-related disease is debated. A systematic literature review was conducted to establish the duration and magnitude of cross-protection in interventional and observational studies. METHODS PubMed and Embase databases were searched to identify randomized controlled trials (RCT) and observational studies published between 2008 and 2019 reporting on efficacy and effectiveness of HPV vaccines in women against non-vaccine types 31, 33, 45, 52, 58, and 6 and 11 (non-bivalent types). Key outcomes of interest were vaccine efficacy against 6- and 12-month persistent infection or genital lesions, and type-specific genital HPV prevalence or incidence. RCT data were analyzed for the according-to-protocol (bivalent vaccine) or negative-for-14-HPV-types (quadrivalent vaccine) efficacy cohorts. RESULTS Data from 23 RCTs and 33 observational studies evaluating cross-protection were extracted. RCTs assessed cross-protection in post-hoc analyses of small size subgroups. Among fully vaccinated, baseline HPV-naïve women, the bivalent vaccine showed statistically significant cross-protective efficacy, although with wide confidence intervals, against 6-month and 12-month persistent cervical infections and CIN2+ only consistently for HPV 31 and 45, with the highest effect observed for HPV 31 (range 64.6% [95% CI: 27.6 to 83.9] to 79.1% [97.7% CI: 27.6 to 95.9] for 6-month persistent infection; maximal follow-up 4.7 years). No cross-protection was shown in extended follow-up. The quadrivalent vaccine efficacy reached statistical significance for HPV 31 (46.2% [15.3-66.4]; follow-up: 3.6 years). Similarly, observational studies found consistently significant effectiveness only against HPV 31 and 45 with both vaccines. CONCLUSIONS RCTs and observational studies show that cross-protection is inconsistent across non-vaccine HPV types and is largely driven by HPV 31 and 45. Furthermore, existing data suggest that it wanes over time; its long-term durability has not been established.
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11
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Thomas A, Necchi A, Muneer A, Tobias-Machado M, Tran ATH, Van Rompuy AS, Spiess PE, Albersen M. Penile cancer. Nat Rev Dis Primers 2021; 7:11. [PMID: 33574340 DOI: 10.1038/s41572-021-00246-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 12/27/2022]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare cancer with orphan disease designation and a prevalence of 0.1-1 per 100,000 men in high-income countries, but it constitutes up to 10% of malignancies in men in some African, Asian and South American regions. Risk factors for PSCC include the absence of childhood circumcision, phimosis, chronic inflammation, poor penile hygiene, smoking, immunosuppression and infection with human papillomavirus (HPV). Several different subtypes of HPV-related and non-HPV-related penile cancers have been described, which also have different prognostic profiles. Localized disease can be effectively managed by topical therapy, surgery or radiotherapy. As PSCC is characterized by early lymphatic spread and imaging is inadequate for the detection of micrometastatic disease, correct and upfront surgical staging of the inguinal lymph nodes is crucial in disease management. Advanced stages of disease require multimodal management. Optimal sequencing of treatments and patient selection are still being investigated. Cisplatin-based chemotherapy regimens are the mainstay of systemic therapy for advanced PSCC, but they have poor and non-durable responses and high rates of toxic effects, indicating a need for the development of more effective and less toxic therapeutic options. Localized and advanced penile cancers and their treatment have profound physical and psychosexual effects on the quality of life of patients and survivors by altering sexual and urinary function and causing lymphoedema.
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Affiliation(s)
- Anita Thomas
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Urology, University Hospitals Leuven, Leuven, Belgium.,Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Andrea Necchi
- Genitourinary Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Asif Muneer
- Department of Urology, University College London Hospitals, London, UK.,National Institute for Health Research (NIHR) Biomedical Research Centre, University College London Hospitals, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Marcos Tobias-Machado
- Section of Urologic Oncology, Department of Urology, ABC Medical School, Instituto do Cancer Vieira de Carvalho, São Paulo, Brazil
| | - Anna Thi Huyen Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Maarten Albersen
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium. .,Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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12
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González JV, Deluca GD, Correa RM, Liotta DJ, Basiletti JA, Fellner MD, Colucci MC, Alzogaray OG, Katz N, Carmona JJ, Tappari NF, Berner E, Cramer V, Real P, López Kaufman CV, Kosoy GJ, Katabian L, Severino MS, Aboslaiman RE, Chami C, Totaro ME, Rogoski C, Giurgiovich AJ, Martínez GL, Plana LM, Vizzotti C, Picconi MA. Strong reduction in prevalence of HPV16/18 and closely related HPV types in sexually active adolescent women following the introduction of HPV vaccination in Argentina. ACTA ACUST UNITED AC 2020; 10:100208. [PMID: 33161174 PMCID: PMC7683272 DOI: 10.1016/j.pvr.2020.100208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/07/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
HPV16/18 decreased by >93% in vaccinated sexually active Argentine girls. Detected reduction of HPV31 and 45 would add to the success of immunization. No genotype replacement was observed. First HPV vaccination monitoring data reported from a Latin American country.
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Affiliation(s)
- Joaquín Víctor González
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia para HPV, Instituto Nacional de Enfermedades Infecciosas -ANLIS "Dr. Malbrán", Av. Velez Sársfield 563, C1282AFF, Buenos Aires, Argentina.
| | - Gerardo Daniel Deluca
- Facultad de Medicina, Universidad Nacional Del Nordeste, Mariano Moreno 1240, W3400ACX, Corrientes, Argentina.
| | - Rita Mariel Correa
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia para HPV, Instituto Nacional de Enfermedades Infecciosas -ANLIS "Dr. Malbrán", Av. Velez Sársfield 563, C1282AFF, Buenos Aires, Argentina.
| | - Domingo Javier Liotta
- Laboratorio de Biología Molecular Aplicada, Facultad de Ciencias Exactas, Quimicas y Naturales, Universidad Nacional de Misiones, Av. Mariano Moreno 1375, N3300, Posadas, Misiones, Argentina; Instituto Nacional de Medicina Tropical- ANLIS "Dr. Malbrán", Neuquén y Jujuy S/n, N3370, Puerto Iguazú, Misiones, Argentina.
| | - Jorge Alejandro Basiletti
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia para HPV, Instituto Nacional de Enfermedades Infecciosas -ANLIS "Dr. Malbrán", Av. Velez Sársfield 563, C1282AFF, Buenos Aires, Argentina.
| | - María Dolores Fellner
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia para HPV, Instituto Nacional de Enfermedades Infecciosas -ANLIS "Dr. Malbrán", Av. Velez Sársfield 563, C1282AFF, Buenos Aires, Argentina.
| | - María Celeste Colucci
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia para HPV, Instituto Nacional de Enfermedades Infecciosas -ANLIS "Dr. Malbrán", Av. Velez Sársfield 563, C1282AFF, Buenos Aires, Argentina.
| | - Olga Gabriela Alzogaray
- Centro Integral de Salud La Banda, Av. San Martín 449, G4300, La Banda, Santiago Del Estero, Argentina.
| | - Nathalia Katz
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de La Nación, Rivadavia 875, C1002AAG, Buenos Aires, Argentina.
| | - Juan José Carmona
- Servicio Ginecología, Hospital Escuela de Agudos "Ramón Madariaga", Av. Marconi 3736, N3300, Posadas, Misiones, Argentina.
| | - Néstor Fabián Tappari
- Servicio Ginecología, Hospital Escuela de Agudos "Ramón Madariaga", Av. Marconi 3736, N3300, Posadas, Misiones, Argentina.
| | - Enrique Berner
- Servicio de Adolescencia, Hospital General de Agudos "Dr. Cosme Argerich", Gral. Urquiza 609, C1221 ADC, Buenos Aires, Argentina.
| | - Viviana Cramer
- Servicio de Adolescencia, Hospital General de Agudos "Dr. Cosme Argerich", Gral. Urquiza 609, C1221 ADC, Buenos Aires, Argentina.
| | - Paula Real
- Servicio de Adolescencia, Hospital General de Agudos "Dr. Cosme Argerich", Gral. Urquiza 609, C1221 ADC, Buenos Aires, Argentina.
| | - Carlota Viviana López Kaufman
- Sección Adolescencia, Hospital General de Agudos "Bernardino Rivadavia", Av. Gral. Las Heras 2670, C1425ASQ, Buenos Aires, Argentina.
| | - Gabriela Judit Kosoy
- Sección Adolescencia, Hospital General de Agudos "Bernardino Rivadavia", Av. Gral. Las Heras 2670, C1425ASQ, Buenos Aires, Argentina.
| | - Lucía Katabian
- Sección Adolescencia, Hospital General de Agudos "Bernardino Rivadavia", Av. Gral. Las Heras 2670, C1425ASQ, Buenos Aires, Argentina.
| | - María Silvia Severino
- Servicio Adolescencia, Hospital General de Agudos "Carlos Durand", Av. Díaz Vélez 5044, C1405DCS, Buenos Aires, Argentina.
| | | | - Cecilia Chami
- Sub Programa Salud Integral Del Adolescente, Ministerio de Salud de Santiago Del Estero, Av. Belgrano Sur 2050, Santiago Del Estero, G4200, Argentina.
| | - María Elina Totaro
- Laboratorio de Biología Molecular Aplicada, Facultad de Ciencias Exactas, Quimicas y Naturales, Universidad Nacional de Misiones, Av. Mariano Moreno 1375, N3300, Posadas, Misiones, Argentina.
| | - Carolina Rogoski
- Servicio Ginecología, Hospital Escuela de Agudos "Ramón Madariaga", Av. Marconi 3736, N3300, Posadas, Misiones, Argentina.
| | - Alejandra Julia Giurgiovich
- Consultorio de Adolescencia, Hospital Zonal General de Agudos "Evita Pueblo", Calle 136 3008, B1884, Berazategui, Provincia de Buenos Aires, Argentina.
| | - Gloria Lilian Martínez
- Consultorio de Adolescencia, Hospital Zonal General de Agudos "Evita Pueblo", Calle 136 3008, B1884, Berazategui, Provincia de Buenos Aires, Argentina.
| | - Liliana Marisol Plana
- Consultorio de Adolescencia, Hospital Zonal General de Agudos "Evita Pueblo", Calle 136 3008, B1884, Berazategui, Provincia de Buenos Aires, Argentina.
| | - Carla Vizzotti
- Secretaría de Acceso a La Salud, Ministerio de Salud de La Nación, Av. 9 de Julio 1925, C1073ABA, Buenos Aires, Argentina.
| | - María Alejandra Picconi
- Servicio Virus Oncogénicos, Laboratorio Nacional y Regional de Referencia para HPV, Instituto Nacional de Enfermedades Infecciosas -ANLIS "Dr. Malbrán", Av. Velez Sársfield 563, C1282AFF, Buenos Aires, Argentina.
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13
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Evidence for Missing Positive Results for Human Papilloma Virus 45 (HPV-45) and HPV-59 with the SPF 10-DEIA-LiPA 25 (Version 1) Platform Compared to Type-Specific Real-Time Quantitative PCR Assays and Impact on Vaccine Effectiveness Estimates. J Clin Microbiol 2020; 58:JCM.01626-20. [PMID: 32907991 PMCID: PMC7587105 DOI: 10.1128/jcm.01626-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/01/2020] [Indexed: 11/29/2022] Open
Abstract
Human papillomavirus (HPV) epidemiological and vaccine studies require highly sensitive HPV detection systems. The widely used broad-spectrum SPF10-DEIA-LiPA25 (SPF10 method) has reduced sensitivity toward HPV-45 and -59. Therefore, anogenital samples from the PASSYON study were retrospectively analyzed with type-specific (TS) HPV-45 and -59 real-time quantitative PCR (qPCR) assays. The SPF10 method missed 51.1% of HPV-45 and 76.1% of HPV-59 infections that were detected by the TS qPCR assays. Human papillomavirus (HPV) epidemiological and vaccine studies require highly sensitive HPV detection systems. The widely used broad-spectrum SPF10-DEIA-LiPA25 (SPF10 method) has reduced sensitivity toward HPV-45 and -59. Therefore, anogenital samples from the PASSYON study were retrospectively analyzed with type-specific (TS) HPV-45 and -59 real-time quantitative PCR (qPCR) assays. The SPF10 method missed 51.1% of HPV-45 and 76.1% of HPV-59 infections that were detected by the TS qPCR assays. The viral copy number (VCn) of SPF10-missed HPV-45 and -59 was significantly lower than SPF10-detected HPV-45 and -59 (P < 0.0001 for both HPV types). Sanger sequencing showed no phylogenetic distinction between SPF10-missed and SPF10-detected HPV-59 variants, but variants bearing the A6562G single-nucleotide polymorphism (SNP) in the SPF10 target region were more likely to be missed (P = 0.0392). HPV cooccurrence slightly influenced the detection probability of HPV-45 and -59 with the SPF10 method. Moreover, HPV-59 detection with the SPF10 method was hampered more in nonvaccinated women than vaccinated women, likely due to a stronger masking effect by increased HPV cooccurrence in the former group. Consequently, the SPF10 method led to a strong negative vaccine effectiveness (VE) of –84.6% against HPV-59, while the VE based on TS qPCR was 3.1%. For HPV-45, the relative increase in detection in nonvaccinated women compared vaccinated women was more similar, resulting in comparable VE estimates. In conclusion, this study shows that HPV-45 and -59 detection with the SPF10 method is dependent on factors including VCn, HPV cooccurrence, and vaccination, thereby showing that knowledge of the limitations of the HPV detection method used is of great importance.
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14
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Mehanna H, Bryant TS, Babrah J, Louie K, Bryant JL, Spruce RJ, Batis N, Olaleye O, Jones J, Struijk L, Molijn A, Vorsters A, Rosillon D, Taylor S, D'Souza G. Human Papillomavirus (HPV) Vaccine Effectiveness and Potential Herd Immunity for Reducing Oncogenic Oropharyngeal HPV-16 Prevalence in the United Kingdom: A Cross-sectional Study. Clin Infect Dis 2020; 69:1296-1302. [PMID: 30590469 PMCID: PMC6763631 DOI: 10.1093/cid/ciy1081] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/21/2018] [Indexed: 01/08/2023] Open
Abstract
Background Oropharyngeal cancer incidence is rapidly rising due to human papillomavirus (HPV) type 16 infection. The dearth of data on effectiveness of national female-only vaccination programs in preventing oral HPV infection and potential herd immunity in unvaccinated males has resulted in considerable controversy regarding the need to vaccinate males, especially in countries with high female vaccination coverage. Methods Subjects aged 0–65 years undergoing tonsillectomy for nonmalignant indications were recruited in 6 hospitals in the United Kingdom. Oral samples were collected as follows: oral rinse, tongue base, and pharyngeal wall brushes, then tonsil tissue (tonsillectomy). Vaccination data were obtained from regional health authorities. All samples were centrally tested for HPV DNA by polymerase chain reaction. Results Of 940 subjects, 243 females and 69 males were aged 12–24 years (median age, 18.6 years), with 189 (78%) females and no males vaccinated against HPV. Overall, oropharyngeal HPV-16 prevalence was significantly lower in vaccinated versus unvaccinated females (0.5% vs 5.6%, P = .04). In contrast, prevalence of any oropharyngeal HPV type was similar in vaccinated and unvaccinated females (19% vs 20%, P = .76). Oropharyngeal HPV-16 prevalence in unvaccinated males was similar to vaccinated females (0% vs 0.5%, P > .99), and lower than unvaccinated females (0% vs 5.6%, P = .08). Conclusions Our findings indicate that the UK female-only vaccination program is associated with significant reductions in oropharyngeal HPV-16 infections. These are also the first data to suggest potential herd immunity from female-only vaccination against oropharyngeal HPV infection in contemporaneously aged males.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head and Neck Studies and Education, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - Tyler S Bryant
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaspreet Babrah
- Cancer Research UK Clinical Trials Unit, University of Birmingham, United Kingdom
| | - Karly Louie
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom
| | - Jennifer L Bryant
- Institute of Head and Neck Studies and Education, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - Rachel J Spruce
- Institute of Head and Neck Studies and Education, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - Nikolaos Batis
- Institute of Head and Neck Studies and Education, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - Oladejo Olaleye
- Institute of Head and Neck Studies and Education, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - June Jones
- Institute of Head and Neck Studies and Education, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
| | - Linda Struijk
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Anco Molijn
- DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - Alex Vorsters
- Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, GlaxoSmithKline, Wavre, Belgium
| | - Dominique Rosillon
- Clinical and Epidemiology Research Development, GlaxoSmithKline, Wavre, Belgium
| | - Sylvia Taylor
- Clinical and Epidemiology Research Development, GlaxoSmithKline, Wavre, Belgium
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Bogaards JA, van der Weele P, Woestenberg PJ, van Benthem BHB, King AJ. Bivalent Human Papillomavirus (HPV) Vaccine Effectiveness Correlates With Phylogenetic Distance From HPV Vaccine Types 16 and 18. J Infect Dis 2020; 220:1141-1146. [PMID: 31165164 PMCID: PMC6736382 DOI: 10.1093/infdis/jiz280] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022] Open
Abstract
To substantiate cross-protection reported across AS04-adjuvanted bivalent human papillomavirus (HPV) vaccine (2vHPV) studies, we reevaluated vaccine effectiveness against type-specific HPV positivity as a function of phylogenetic distance to vaccine target types HPV-16 and -18. We provide evidence of sustained cross-protection up to 8 years postvaccination in a high-risk population in the Netherlands. Moreover, our findings suggest that genomic distance better explains cross-protection than distance measures based on capsid antigens only. Taken together, 2vHPV is predicted to provide partial cross-protection against HPV-31, -33, -35, -45, -52, and possibly -58, that is, acknowledged oncogenic types with close phylogenetic relationships to HPV-16 or -18.
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Affiliation(s)
- Johannes A Bogaards
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven.,Department of Epidemiology and Biostatistics, Maastricht University Medical Centre, The Netherlands
| | - Pascal van der Weele
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven.,Department of Pathology, Vrije Universiteit Amsterdam, Amsterdam University Medical Centres, Maastricht University Medical Centre, The Netherlands
| | - Petra J Woestenberg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven.,Care and Public Health Research Institute, Maastricht University Medical Centre, The Netherlands
| | - Birgit H B van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
| | - Audrey J King
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven
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16
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Systematic Review and Meta-analysis of Postlicensure Observational Studies on Human Papillomavirus Vaccination and Autoimmune and Other Rare Adverse Events. Pediatr Infect Dis J 2020; 39:287-293. [PMID: 31876615 DOI: 10.1097/inf.0000000000002569] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the limited number of subjects in prelicensure studies, autoimmune diseases and other rare adverse effects of vaccines may go undetected. Since 2006, millions of human papillomavirus (HPV) vaccine doses have been distributed and a considerable amount of postlicensure safety data has been generated. The objective of this study was to review available HPV postlicensure safety studies and to summarize risk estimates of autoimmune and other rare diseases. METHODS For this systematic review and meta-analysis, we searched literature databases to identify any postlicensure safety studies related to HPV vaccination and autoimmune adverse events from inception to April 16, 2019. Pooled risk estimates were computed using fixed- or random-effects models if at least 2 estimates per disease and per HPV vaccine were available. RESULTS Twenty-two studies met our inclusion criteria. The studies applied various methodologies and used different types of data sources and outcome definitions. Quadrivalent HPV vaccine (4vHPV) was most commonly assessed. Type 1 diabetes mellitus, immune thrombocytopenia purpura and thyroiditis diseases were most frequently reported. The meta-analysis was conducted on 35 diseases corresponding to 48 pooled risk estimates. Majority of the pooled estimates showed no significant effect (n = 43). Three negative (paralysis, immune thrombocytopenia purpura and chronic fatigue syndrome) and 2 positive (Hashimoto and Raynaud diseases) associations were detected. CONCLUSION Our study demonstrated an absence of clear association between HPV vaccines and autoimmune and other rare diseases. The review also highlights the need for more systematic collaborations to monitor rare safety adverse events.
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17
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Provider Experience Recommending HPV Vaccination Before Age 11 Years. J Pediatr 2020; 217:92-97. [PMID: 31757474 DOI: 10.1016/j.jpeds.2019.10.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/05/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To describe health care providers' experiences recommending human papillomavirus (HPV) vaccination before age 11 years as part of a multisession intervention to improve HPV vaccination coverage. STUDY DESIGN Between 2016 and 2018, we conducted 30-minute qualitative interviews with intervention participants approximately 1 month after intervention completion. Interviews explored participants' experiences with new strategies, including changing the age of routine recommendation. Thematic analysis of interview transcripts involved both deductive and inductive approaches. RESULTS Twenty-six participants at 5 clinical sites were interviewed. Most were female (88%) primary care providers (46%), and worked 1.5-3.0 clinical days weekly. Many providers described initial skepticism about recommending vaccination before age 11 years, fearing that removing the HPV vaccine from the adolescent bundle with tetanus and meningitis vaccines would decrease parental acceptance. However, providers uniformly reported high parental acceptance owing to reduced stigma relating to sexual activity and the opportunity to administer fewer shots at each visit. Providers also noted that initiating vaccination earlier increased opportunities to complete the series and decreased the need for resource-intensive vaccine recall programs. CONCLUSIONS Providers had positive experiences recommending HPV vaccination before age 11 years. Routine recommendation before age 11 years may offer advantages related to fewer shots per visit, fewer missed opportunities, and reduction of parental concerns related to sexual activity.
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18
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Hancock G, Blight J, Lopez-Camacho C, Kopycinski J, Pocock M, Byrne W, Price MJ, Kemlo P, Evans RI, Bloss A, Saunders K, Kirton R, Andersson M, Hellner K, Reyes-Sandoval A, Dorrell L. A multi-genotype therapeutic human papillomavirus vaccine elicits potent T cell responses to conserved regions of early proteins. Sci Rep 2019; 9:18713. [PMID: 31822717 PMCID: PMC6904585 DOI: 10.1038/s41598-019-55014-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/20/2019] [Indexed: 12/13/2022] Open
Abstract
Despite an efficacious prophylactic human papillomavirus (HPV) vaccine there is still a considerable global burden of HPV-related disease. Therapeutic vaccines that could prevent cancers in at-risk women are urgently needed. Most candidate therapeutic vaccines have focused on two high-risk (hr) HPV genotypes, 16 and 18, and two viral targets, E6 and E7, which may limit global coverage and efficacy. We designed the synthetic gene '5GHPV3' by selecting conserved regions from each of the six early proteins and generating consensus sequences to represent five hrHPV genotypes. 5GHPV3 was delivered by plasmid DNA, chimpanzee adenovirus (ChAdOx1) and modified vaccinia Ankara (MVA) vectors in prime-boost regimens to mice. ChAdOx1-5GHPV3 / MVA-5GHPV3 induced higher magnitude and more durable HPV-specific T cell responses than other regimens. Vaccine-induced T cells were polyfunctional and persisted at high frequencies for at least six weeks. Importantly, HPV-specific effector CD8 + T cells were detected in the cervix following systemic administration of ChAdOx1-5GHPV3 / MVA-5GHPV3 and increased in frequency over time, indicating continued trafficking of T cells to the cervix. Finally, T cells specific for 5GHPV3 encoded antigens were detected by IFN-γ Elispot in women with current or past hrHPV infections, confirming the presence of epitopes relevant to natural immune control.
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Affiliation(s)
- Gemma Hancock
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Oxford, UK.
| | - Joshua Blight
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Roosevelt Drive, Oxford, UK
| | - Cesar Lopez-Camacho
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Roosevelt Drive, Oxford, UK
| | - Jakub Kopycinski
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Oxford, UK
| | - Mamatha Pocock
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Oxford, UK
| | - Wendy Byrne
- Direct Delivery Team, NIHR Clinical Research Network Thames Valley and South Midlands, Nuffield Orthopaedic Centre, Block 8, Oxford, OX3 7LD, UK
| | - Michael J Price
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Oxford, UK
| | - Phillip Kemlo
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Roosevelt Drive, Oxford, UK
| | - Ranoromanana Ionitiana Evans
- Direct Delivery Team, NIHR Clinical Research Network Thames Valley and South Midlands, Nuffield Orthopaedic Centre, Block 8, Oxford, OX3 7LD, UK
| | - Angela Bloss
- Direct Delivery Team, NIHR Clinical Research Network Thames Valley and South Midlands, Nuffield Orthopaedic Centre, Block 8, Oxford, OX3 7LD, UK
| | - Kathryn Saunders
- Direct Delivery Team, NIHR Clinical Research Network Thames Valley and South Midlands, Nuffield Orthopaedic Centre, Block 8, Oxford, OX3 7LD, UK
| | - Richard Kirton
- Microbiology Department, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Monique Andersson
- Microbiology Department, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Karin Hellner
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Arturo Reyes-Sandoval
- The Jenner Institute, Nuffield Department of Medicine, University of Oxford, The Henry Wellcome Building for Molecular Physiology, Roosevelt Drive, Oxford, UK
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford and Oxford NIHR Biomedical Research Centre, NDM Research Building, Old Road Campus, Oxford, UK
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Monitoring human papillomavirus prevalence among young Australian women undergoing routine chlamydia screening. Vaccine 2019; 38:1186-1193. [PMID: 31767467 DOI: 10.1016/j.vaccine.2019.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/21/2019] [Accepted: 11/08/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Australia has recently implemented major changes in cervical cancer prevention policies including introduction of primary human papillomavirus (HPV) screening starting at age 25, and replacement of the quadrivalent HPV vaccine with the nonavalent vaccine in the national school-based program. We assessed the feasibility and utility of conducting HPV testing in residual clinical specimens submitted for routine Chlamydia trachomatis screening, as a means of tracking HPV vaccine program impact among young sexually active women. METHODS De-identified residual specimens from women aged 16-24 years submitted for chlamydia testing were collected from three pathology laboratories in Victoria and New South Wales. Limited demographic information, and chlamydia test results were also collected. Patient identifiers were sent directly from the laboratories to the National HPV Vaccination Program Register, to obtain HPV vaccination histories. Samples underwent HPV genotyping using Seegene Anyplex II HPV 28 assay. RESULTS Between April and July 2018, 362 residual samples were collected, the majority (60.2%) of which were cervical swabs. Demographic data and vaccination histories were received for 357 (98.6%) women (mean age 21.8, SD 2.0). Overall, 65.6% of women were fully vaccinated, 9.8% partially, and 24.7% unvaccinated. The majority (86.0%) resided in a major city, 35.9% were classified in the upper quintile of socioeconomic advantage and chlamydia positivity was 7.8%.The prevalence of quadrivalent vaccine-targeted types (HPV6/11/16/18) was 2.8% (1.5-5.1%) overall with no differences by vaccination status (p = 0.729). The prevalence of additional nonavalent vaccine-targeted types (HPV31/33/45/52/58) was 19.3% (15.6-23.8%). One or more oncogenic HPV types were detected in 46.8% (95% CI 41.6-52.0%) of women. CONCLUSIONS HPV testing of residual chlamydia specimens provides a simple, feasible method for monitoring circulating genotypes. Applied on a larger scale this method can be utilised to obtain a timely assessment of nonavalent vaccine impact among young women not yet eligible for cervical screening.
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Drolet M, Bénard É, Pérez N, Brisson M. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet 2019; 394:497-509. [PMID: 31255301 PMCID: PMC7316527 DOI: 10.1016/s0140-6736(19)30298-3] [Citation(s) in RCA: 542] [Impact Index Per Article: 108.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination. METHODS In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks. FINDINGS We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5-8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11-0·25) among girls aged 13-19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23-0·49) among women aged 20-24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33-0·66) among girls aged 13-19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24-0·46) among girls aged 15-19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36-0.60) among women aged 20-24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53-0·89) among women aged 25-29 years. Among boys aged 15-19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37-0·75) and among men aged 20-24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47-0·98). After 5-9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42-0·58) among screened girls aged 15-19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57-0·84) among women aged 20-24 years. INTERPRETATION This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects. FUNDING WHO, Canadian Institutes of Health Research, Fonds de recherche du Québec - Santé.
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Affiliation(s)
- Mélanie Drolet
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Élodie Bénard
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Norma Pérez
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Marc Brisson
- Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada; Department of Infectious Disease Epidemiology, Imperial College, London, UK.
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Hirth JM, Kuo YF, Starkey JM, Rupp RE, Laz TH, Rahman M, Berenson AB. Regional variations in human papillomavirus prevalence across time in NHANES (2003-2014). Vaccine 2019; 37:4040-4046. [PMID: 31182324 DOI: 10.1016/j.vaccine.2019.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The consequences of low human papillomavirus (HPV) vaccination in Census regions with higher incidence of cervical cancer may contribute to continued disparities. Our purpose was to evaluate regional variations in HPV prevalence across time. METHODS Repeated cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 2003-2014 were examined. Participants included females 14 to 34 years old who provided adequate vaginal samples for HPV DNA typing (N = 6387). Region of residence and HPV vaccination status associations with HPV prevalence were examined using chi-square and multivariable logistic regression. HPV types were grouped according to vaccine-type HPV (types 6, 11, 16, 18) and risk (high or low-risk). Time and vaccination status were included in subsequent models for post-licensure survey cycles (2007-2014) to assess their effects on observed associations. RESULTS No decreases in vaccine-type HPV prevalence were found between the prevaccine cycles (2003-2006) and early post-licensure cycles (2007-2010, p > 0.05). Vaccine-type HPV prevalence decreased in late post-licensure years (2011-2014) compared to prevaccine years (2003-2006, p = 0.001). The highest prevalence of vaccine-type HPV occurred in the South (8.6%) and Midwest (8.6%), followed by the West (4.8%), and the Northeast (3.5%) in late post-licensure years. Lower odds of vaccine-type HPV across time in post-licensure survey cycles were found to be attributable to time, and more strongly to HPV vaccination. CONCLUSIONS There were regional variations in vaccine-type HPV prevalence between prevaccine and post-licensure years. These decreases appeared to be at least partially attributable to HPV vaccination. Programs are needed to address geographical disparities in HPV vaccination.
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Affiliation(s)
- Jacqueline M Hirth
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, United States.
| | - Yong-Fang Kuo
- Department of Biostatistics and Epidemiology, University of Texas Medical Branch, Galveston, TX, United States
| | - Jonathan M Starkey
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Richard E Rupp
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, United States
| | - Tabassum H Laz
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Mahbubur Rahman
- Division of Epidemiology, Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, Department of Obstetrics & Gynecology, University of Texas Medical Branch, Galveston, TX, United States
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22
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Wright TC, Parvu V, Stoler MH, Kodsi S, Eckert K, Yanson K, Cooper CK. HPV infections and cytologic abnormalities in vaccinated women 21–34 years of age: Results from the baseline phase of the Onclarity trial. Gynecol Oncol 2019; 153:259-265. [DOI: 10.1016/j.ygyno.2019.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 01/07/2023]
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23
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Woestenberg PJ, King AJ, van Benthem BHB, Donken R, Leussink S, van der Klis FRM, de Melker HE, van der Sande MAB, Hoebe CJPA, Bogaards JA. Bivalent Vaccine Effectiveness Against Type-Specific HPV Positivity: Evidence for Cross-Protection Against Oncogenic Types Among Dutch STI Clinic Visitors. J Infect Dis 2019; 217:213-222. [PMID: 29140439 PMCID: PMC5853250 DOI: 10.1093/infdis/jix582] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023] Open
Abstract
Background Observational postmarketing studies are important to assess vaccine effectiveness (VE). We estimated VE from the bivalent human papillomavirus (HPV) vaccine against HPV positivity of vaccine and nonvaccine types in a high-risk population. Methods We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional survey in Dutch sexually transmitted infection clinics. Vaginal swabs were analyzed using a polymerase chain reaction-based assay (SPF10-LiPA25) able to detect the 12 high-risk HPV (hrHPV) types 16/18/31/33/35/39/45/51/52/56/58/59. We compared hrHPV positivity between self-reported vaccinated (≥1 dose) and unvaccinated women, and estimated VE by a logistic mixed model. Results We included 1087 women of which 53% were hrHPV positive and 60% reported to be vaccinated. The adjusted pooled VE against HPV-16/18 was 89.9% (81.7%-94.4%). Moreover, we calculated significant VE against nonvaccine types HPV-45 (91%), HPV-35 (57%), HPV-31 (50%), and HPV-52 (37%). Among women who were offered vaccination 5/6 years ago, we estimated similar VE against HPV-16/18 (92%) and all hrHPV types (35%) compared to women who were offered vaccination <5 years ago (83% and 33%, respectively). Conclusion We demonstrated high VE of the bivalent vaccine against HPV-16/18 and cross-protection against HPV-45/35/31/52. Protection against HPV-16/18 was sustained up to 6 years postvaccination.
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Affiliation(s)
- Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Audrey J King
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Birgit H B van Benthem
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Robine Donken
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suzan Leussink
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Fiona R M van der Klis
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Hester E de Melker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands
| | - Marianne A B van der Sande
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Julius Center, University Medical Center Utrecht, The Netherlands.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christian J P A Hoebe
- Care and Public Health Research Institute, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environment, South Limburg Public Health Service, Geleen
| | - Johannes A Bogaards
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Maastricht University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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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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Woestenberg PJ, Bogaards JA, King AJ, Leussink S, van der Sande MA, Hoebe CJ, van Benthem BH. Assessment of herd effects among women and heterosexual men after girls-only HPV16/18 vaccination in the Netherlands: A repeated cross-sectional study. Int J Cancer 2018; 144:2718-2727. [PMID: 30426502 PMCID: PMC6590597 DOI: 10.1002/ijc.31989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/12/2018] [Accepted: 11/02/2018] [Indexed: 01/07/2023]
Abstract
Data on the impact of human papillomavirus (HPV) vaccination on the population HPV prevalence are largely obtained from women. We assessed the impact of the girls‐only HPV16/18 vaccination program in the Netherlands that started in 2009, on trends in HPV prevalence among women and heterosexual men, using data from the PASSYON study. In this cross‐sectional study, the HPV prevalence among 16‐ to 24‐year‐old visitors to sexually transmitted infection clinics was assessed in 2009, 2011, 2013, and 2015. We compared the genital postvaccination HPV prevalence with the prevaccination prevalence (2009) using Poisson GEE models. In total, we included 4,996 women and 1,901 heterosexual men. The percentage of women who reported to be vaccinated increased from 2.3% in 2009 to 37% in 2015. Among all women, the HPV16/18 prevalence decreased from 23% prevaccination to 15% in 2015 (adjusted prevalence ratio [aPR] 0.62, ptrend < 0.01). Among heterosexual men, the HPV16/18 prevalence decreased from 17% prevaccination to 11% in 2015 (aPR 0.52, ptrend < 0.01). Of the heterosexual men with a steady partner, HPV16/18 prevalence was lower among those whose steady partner had been vaccine‐eligible in the national immunization program (aPR 0.13). Among unvaccinated women, the HPV16/18 prevalence in 2015 was not different from prevaccination. The decreasing HPV16/18 prevalence among heterosexual men and the reduced HPV16/18 prevalence among heterosexual men with a vaccine‐eligible steady partner strongly suggests herd protection from girls‐only vaccination. Absence of notable herd effects among unvaccinated women 6 years postvaccination may be due to the moderate vaccine uptake among girls in the Netherlands. What's new? Human papillomavirus (HPV) is a sexually transmitted virus that plays a causal role in the development of anogenital and oropharyngeal cancers in both men and women. The population‐level impact of HPV vaccination programs on the HPV prevalence has however mainly been studied in women. This study shows decreasing trends in the HPV16 and HPV18 prevalence among both women and heterosexual men after the introduction of a girls‐only HPV16/18 vaccination program in the Netherlands. The findings provide compelling evidence for herd protection in men. Because HPV16/18 are the most oncogenic types, HPV‐related cancers are expected to decline in both sexes after girls‐only HPV vaccination.
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Affiliation(s)
- Petra J Woestenberg
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Johannes A Bogaards
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Audrey J King
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Suzan Leussink
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marianne Ab van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Christian Jpa Hoebe
- Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environment, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Birgit Hb van Benthem
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Changes in human papillomavirus genotypes associated with cervical intraepithelial neoplasia grade 2 lesions in a cohort of young women (2013-2016). PAPILLOMAVIRUS RESEARCH 2018; 6:77-82. [PMID: 30391363 PMCID: PMC6260284 DOI: 10.1016/j.pvr.2018.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 09/06/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
Abstract
In 2008, a quadrivalent human papillomavirus (HPV) vaccine (genotypes 6, 11, 16, 18) became available in New Zealand. This study investigated whether the proportion of cervical intraepithelial neoplasia grade 2 (CIN2) lesions associated with HPV genotypes 16 and 18 changed over time in young women recruited to a prospective CIN2 observational management trial (PRINCess) between 2013 and 2016. Partial HPV genotyping (16, 18, or other high risk HPV) was undertaken on n = 392 women under 25 years (mean age 21.8, range 17–24) with biopsy-diagnosed CIN2. High risk HPV genotypes were detected in 96% of women with CIN2 lesions. Between 2013 and 2016, the proportion of women whose liquid-based cytology samples were HPV 16 or 18 positive decreased from 43% to 13%. HPV vaccination status was known for 78% of women. Between 2013 and 2016, the proportion of HPV 16/18 positivity did not significantly change in HPV-vaccinated women, but decreased from 66% to 17% in unvaccinated women. The reducing proportion of HPV 16/18-related CIN2 in our cohort of young New Zealand women may be attributable to the introduction of a national HPV vaccination program. The substantial decrease in HPV 16/18 positivity observed in unvaccinated women is likely to be due to a herd effect. 392 women under 25 years with CIN2 lesions were recruited between 2013 and 2016. HPV16/18 positivity decreased from 43% of women in 2013–13% in 2016. In vaccinated women, HPV16/18 positivity decreased from 17% in 2013 to 9% in 2016. In unvaccinated women, HPV16/18 positivity decreased from 66% in 2013 to 17% in 2016. Decreasing HPV16/18-related CIN2 may be due to HPV vaccination and herd effect.
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Hirth J, McGrath CJ, Kuo YF, Rupp RE, Starkey JM, Berenson AB. Impact of human papillomavirus vaccination on racial/ethnic disparities in vaccine-type human papillomavirus prevalence among 14-26 year old females in the U.S. Vaccine 2018; 36:7682-7688. [PMID: 30377066 DOI: 10.1016/j.vaccine.2018.10.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Low human papillomavirus (HPV) vaccination rates early after introduction, particularly among low income and minority adolescents, may have resulted in disparities in vaccine-type HPV prevalence (types 6, 11, 16, 18). The purpose of this study was to examine racial/ethnic variations in HPV prevalence, and evaluate how HPV vaccination has affected vaccine-type HPV prevalence across time. METHODS This study was a retrospective analysis of 6 cycles of the National Health and Nutrition Examination Survey (NHANES) data (2003-2014). Results on HPV status from vaginal samples of 14-26 year old females who responded about HPV vaccination were used to determine HPV prevalence. Prevaccine HPV prevalence was compared to post-licensure prevalence. Racial/ethnic comparisons were made across time, and models were developed to examine the role of HPV vaccination in observed variations for vaccine-type HPV prevalence. RESULTS Among 4080 females, 29.7% were black, 25.6% were Mexican American, 8.9% were Hispanic, and 35.8% were white. Compared to prevaccine years (2003-2006), vaccine-type HPV did not decrease until late post-licensure years (2011-2014; 14.2% vs. 5.2%, p < 0.001). Most of the decrease occurred among white females between prevaccine and late post-licensure periods (15.2% vs. 4.1%, p < 0.001). Although a decrease in prevalence was observed among black females during the same periods (16.9% vs. 9.8%, p < 0.05), it was not as large as among white females. Prevalence decreased among Mexican Americans (8.2 vs. 4.0, p > 0.05) during the same periods, but the difference was not significant. Interactions between race and time were significant (p < 0.001), with uneven vaccination between black and white females contributing to the disparities observed. CONCLUSIONS HPV vaccination was low in among black and Mexican American females, which contributed to disparities in HPV prevalence. Increasing vaccination among all adolescents, particularly 11-12 year olds, is important because most children this age will not have been exposed.
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Affiliation(s)
- Jacqueline Hirth
- Department of Obstetrics & Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555 United States.
| | - Christine J McGrath
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Yong-Fang Kuo
- Office of Biostatistics, Division of Epidemiology and Biostatistics, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States
| | - Richard E Rupp
- Department of Pediatrics, School of Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Jonathan M Starkey
- Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Abbey B Berenson
- Department of Obstetrics & Gynecology, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston, TX, United States
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Ferreira Costa AP, Gonçalves AK, Machado PRL, Souza LBFCD, Sarmento A, Cobucci RNO, Giraldo PC, Witkin SS. Immune Response to Human Papillomavirus One Year after Prophylactic Vaccination with AS04-Adjuvanted HPV-16/18 Vaccine: HPV-Specific IgG and IgA Antibodies in the Circulation and the Cervix. Asian Pac J Cancer Prev 2018; 19:2313-2317. [PMID: 30141308 PMCID: PMC6171383 DOI: 10.22034/apjcp.2018.19.8.2313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: This study was designed to describe the course of IgG/IgA responses in cervical secretions and in serum one year after the first dose of intramuscular administration of the HPV16/18 AS04-adjuvant vaccine. Methods: Blood and cervical mucus samples were collected for immunologic assays, 7 months after the first doses and 1 year following the last boost vaccination (month 7) by enzyme linked immunosorbent assay (ELISA). The detection of IgG and IgA anti-HPV/VLP was developed for this purpose. Result: A total of 100% of serum samples were IgG antibody positive at a titer of 1:100 at both time periods and decreased according to the serum dilution. For serum IgA antibody, 95% were positive one month after vaccination and 79% were positive 1 year later. Similar results were observed with the cervical samples positive for both IgG and IgA antibodies at one month and decreasing after 1 year to 33% and 29%. The median absorbance in serum and the cervix for IgG and IgA anti-HPV-VLP antibodies was significantly higher at one month after vaccination when compared to 1 year post-vaccination (P<0.0001). Conclusion: Immune responses were significant one year after immunization, however it decreased in cervical and serum samples when compared to levels observed one month after the last dose. This suggests that a vaccine booster may be necessary to increase antibody titers.
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Affiliation(s)
- Ana Paula Ferreira Costa
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.
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Ponce-Benavente L, Rejas-Pinelo P, Aguilar-Luis MA, Palomares-Reyes C, Becerra-Goicochea L, Pinillos-Vilca L, Silva-Caso W, Costa LE, Weilg P, Alvitrez-Arana J, Bazán-Mayra J, Del Valle-Mendoza J. Frequency and coinfection between genotypes of human papillomavirus in a population of asymptomatic women in northern Peru. BMC Res Notes 2018; 11:530. [PMID: 30064521 PMCID: PMC6069864 DOI: 10.1186/s13104-018-3644-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Describe the prevalence of HPV genotypes via PCR and DNA sequencing in 397 women who attended to the gynecological outpatient center in the Hospital Regional Docente de Cajamarca from March to September 2017. Results A positive PCR result for HPV was observed in 121 cervical samples. A high-risk genotype was found in 63.6% (77/121) of patients, a probably oncogenic type in 23.1% (28/121) and a low-risk type in 7.4%. Among the high-risk genotypes, HPV-31 was the most common one present in 20% (21/77), followed by HPV-16 in 11.4% (12/77). Coinfections between two or more genotypes were observed in 12 cases. Electronic supplementary material The online version of this article (10.1186/s13104-018-3644-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luis Ponce-Benavente
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Patricia Rejas-Pinelo
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Miguel Angel Aguilar-Luis
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Laboratorio de Biología Molecular, Instituto de Investigación Nutricional, Lima, Peru.,Instituto de Investigación de Enfermedades Infecciosas, Lima, Peru
| | - Carlos Palomares-Reyes
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | - Wilmer Silva-Caso
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Pablo Weilg
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Juan Alvitrez-Arana
- Instituto de Investigación de Enfermedades Infecciosas, Lima, Peru.,Hospital Regional Docente de Cajamarca, Cajamarca, Peru
| | | | - Juana Del Valle-Mendoza
- School of Medicine, Research and Innovation Centre of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. .,Laboratorio de Biología Molecular, Instituto de Investigación Nutricional, Lima, Peru.
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Mesher D, Panwar K, Thomas SL, Edmundson C, Choi YH, Beddows S, Soldan K. The Impact of the National HPV Vaccination Program in England Using the Bivalent HPV Vaccine: Surveillance of Type-Specific HPV in Young Females, 2010–2016. J Infect Dis 2018; 218:911-921. [DOI: 10.1093/infdis/jiy249] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/09/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- David Mesher
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, London, United Kingdom
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kavita Panwar
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Sara L Thomas
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claire Edmundson
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, London, United Kingdom
| | - Yoon Hong Choi
- Statistics, Modeling, and Economics Department, Public Health England, London, United Kingdom
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Kate Soldan
- HIV and STI Department, Centre for Infectious Disease Surveillance and Control, London, United Kingdom
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Malagón T, Laurie C, Franco EL. Human papillomavirus vaccination and the role of herd effects in future cancer control planning: a review. Expert Rev Vaccines 2018; 17:395-409. [PMID: 29715059 DOI: 10.1080/14760584.2018.1471986] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Vaccine herd effects are the indirect protection that vaccinated persons provide to those who remain susceptible to infection, due to the reduced transmission of infections. Herd effects have been an important part of the discourse on how to best implement human papillomavirus (HPV) vaccines and prevent HPV-related diseases. AREAS COVERED In this paper, we review the theory of HPV vaccine herd effects derived from mathematical models, give an account of observed HPV vaccine herd effects worldwide, and examine the implications of vaccine herd effects for future cervical cancer screening efforts. EXPERT COMMENTARY HPV vaccine herd effects improve the cost-effectiveness of vaccinating preadolescent girls, but contribute to making gender-neutral vaccination less economically efficient. Vaccination coverage and sexual mixing patterns by age are strong determinants of herd effects. Many countries worldwide are starting to observe reductions in HPV-related outcomes likely attributable to herd effects, most notably declining anogenital warts in young men, and declining HPV-16/18 infection prevalence in young unvaccinated women. Policy makers making recommendations for cervical cancer screening will have to consider HPV vaccination coverage and herd effects, as these will affect the positive predictive value of screening and the risk of cervical cancer in unvaccinated women.
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Affiliation(s)
- Talía Malagón
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Cassandra Laurie
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
| | - Eduardo L Franco
- a Division of Cancer Epidemiology, Faculty of Medicine , McGill University , Montréal , Canada
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Nah EH, Cho S, Kim S, Cho HI. Human Papillomavirus Genotype Distribution Among 18,815 Women in 13 Korean Cities and Relationship With Cervical Cytology Findings. Ann Lab Med 2018. [PMID: 28643492 PMCID: PMC5500742 DOI: 10.3343/alm.2017.37.5.426] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The prevalence and genotype distribution of Human papillomavirus (HPV) infection vary depending on geographical region and the immunity provided by vaccines. This study aimed to clarify the recent prevalence and genotype distribution of HPV according to age and cervical cytology findings in Korea. METHODS This study included 18,815 health examinees that underwent cervical cytology and HPV genotyping tests at 16 centers of Korean Association of Health Promotion in 13 cities in Korea, between January 2014 and October 2015. HPV was genotyped by using multiplex PCR (Anyplex II HPV 28, Seegene, Korea), which detects 19 high-risk HPVs (HR-HPV) and nine low-risk HPVs (LR-HPV). RESULTS Overall HPV prevalence was 27.8%, with 22.2% HR-HPV and 11.4% LR-HPV. The five most common carcinogens were HPV 52 (3.2%), 58 (2.7%), 16 (2.0%), 56 (1.9%), and 51 (1.8%). The five most common HR-HPVs in normal cytology samples were HPV 53, 68, 70, 52, and 58, while HPV 16, 52, 58, 33, and 31 were prevalent in high grade squamous intraepithelial lesions (HSIL). In atypical squamous cells of undetermined significance (ASCUS), the prevalence of HR-HPV varied with age; it was highest in those aged <30 yr, declining to a minimum at age 50-59 yr, and then increasing in older women (P<0.05). CONCLUSIONS The prevalence and distribution of HR-HPV varied with age and cervical cytology findings. This information would be helpful in the development of cervical cancer prevention policies.
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Affiliation(s)
- Eun Hee Nah
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea.
| | - Seon Cho
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Suyoung Kim
- Department of Laboratory Medicine and Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea
| | - Han Ik Cho
- MEDIcheck LAB, Korea Association of Health Promotion, Cheongju, Korea
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33
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Mesher D, Soldan K, Lehtinen M, Beddows S, Brisson M, Brotherton JML, Chow EPF, Cummings T, Drolet M, Fairley CK, Garland SM, Kahn JA, Kavanagh K, Markowitz L, Pollock KG, Söderlund-Strand A, Sonnenberg P, Tabrizi SN, Tanton C, Unger E, Thomas SL. Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes. Emerg Infect Dis 2018; 22:1732-40. [PMID: 27648688 PMCID: PMC5038419 DOI: 10.3201/eid2210.160675] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20-24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important.
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34
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Goggin P, Sauvageau C, Gilca V, Defay F, Lambert G, Mathieu-C S, Guenoun J, Comète E, Coutlée F. Low prevalence of vaccine-type HPV infections in young women following the implementation of a school-based and catch-up vaccination in Quebec, Canada. Hum Vaccin Immunother 2017; 14:118-123. [PMID: 29049007 DOI: 10.1080/21645515.2017.1385688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In Quebec, Canada, a school-based HPV vaccination for girls has been offered since 2008. The vaccine used in the program targets HPV16/18, responsible for ∼70% of cervical cancers and HPV6/11, responsible for the majority of anogenital warts. The objective of this study was to assess the prevalence of HPV in vaccinated and unvaccinated women. METHODS Women aged 17-29 years were eligible to participate. Participants' age, vaccination status and diverse risk factors were assessed by a computer-assisted questionnaire. Biological specimens were obtained by self-sampling. HPV genotyping was performed by Linear Array. RESULTS A total of 2,118 women were recruited. 2,042 completed the questionnaire and 1,937 provided a vaginal sample. Vaccination coverage varied from 83.5% in women aged 17-19 to 19.1% in those aged 23-29. The overall prevalence of HPV in sexually active women was 39.4% (95%CI: 37.0-41.7) and 56.7% of infected women had multiple type infections. The prevalence of vaccine HPV types varied by age and vaccination status except for women aged 23-29 for whom similar results were observed. Vaccine HPV types were detected in 0.3%, 1.4% and 10.5% of vaccinated women aged 17-19, 20-23, and 23-29 (p<0.05), respectively. HPV16 or HPV18 were detected in 10 women having received at least one dose of vaccine. Nine of these women were already sexually active at the time of vaccination. CONCLUSION Infections with HPV types included in the vaccine are rare in women aged less than 23 years and are virtually absent in those who received at least one dose of vaccine before sexual debut.
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Affiliation(s)
- P Goggin
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - C Sauvageau
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - V Gilca
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - F Defay
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - G Lambert
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - S Mathieu-C
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,c Département de Psychopédagogie et D'andragogi, Faculté des Sciences de L'éducation , Université de Montréal , Montréal , Québec , Canada
| | - J Guenoun
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - E Comète
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - F Coutlée
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada.,e Département de Microbiologie et Immunologie , Université de Montréal , Montréal , Québec , Canada
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35
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Kavanagh K, Pollock KG, Cuschieri K, Palmer T, Cameron RL, Watt C, Bhatia R, Moore C, Cubie H, Cruickshank M, Robertson C. Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1293-1302. [DOI: 10.1016/s1473-3099(17)30468-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023]
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36
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Khoo SP, Bhoo-Pathy N, Yap SH, Anwar Shafii MK, Hairizan Nasir N, Belinson J, Subramaniam S, Goh PP, Zeng M, Tan HD, Gravitt P, Woo YL. Prevalence and sociodemographic correlates of cervicovaginal human papillomavirus (HPV) carriage in a cross-sectional, multiethnic, community-based female Asian population. Sex Transm Infect 2017; 94:277-283. [DOI: 10.1136/sextrans-2017-053320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/17/2017] [Accepted: 11/11/2017] [Indexed: 12/29/2022] Open
Abstract
ObjectivesCervical cancer is a largely preventable disease, and the strategic implementation of a cervical cancer prevention programme is partly dependent on the impact of human papillomavirus (HPV) infection interpreted within the context of the country’s sociodemographic attributes. The objective of this study is to determine the prevalence of cervicovaginal HPV infection among a healthy, community-based, multiethnic Malaysian population. The HPV prevalence was subsequently correlated to the individual’s sociodemographics and sexual/reproductive history. Of significance, the observed prevalence captured was in a birth cohort not included in the national school-based HPV vaccination programme.MethodsThis was a cross-sectional study where 1293 healthy women aged between 18 and 60 years were recruited via convenience sampling from five community-based clinics in Selangor, Malaysia. Cervicovaginal self-samples were obtained and DNA was extracted for HPV detection and genotyping. A comprehensive questionnaire was administered to determine the sociodemographics and behavioural patterns of participants.ResultsThe median age at enrolment was 37 years old (IQR: 30–47). In total, 86/1190 (7.2%) of the samples collected were positive for HPV infection, with the highest HPV prevalence (11.9%) detected in the subgroup of 18–24 years old. The top three most prevalent HPV genotypes were HPV 16, 52 and 58. The independent risk factors associated with higher rates of HPV infection included Indian ethnicity, widowed status and women with partners who are away from home for long periods and/or has another sexual partner.ConclusionsThe overall prevalence of HPV infection in this Malaysian multiethnic population was 7.2%, with 6.5% being high-risk genotypes. The top three most common high-risk HPV types were HPV 16, 52 and 58. This information is important for the planning of primary (HPV vaccination) and secondary (screening) cervical cancer prevention programmes in Malaysia.
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Huang LM, Puthanakit T, Cheng-Hsun C, Ren-Bin T, Schwarz T, Pellegrino A, Esposito S, Frenette L, McNeil S, Durando P, Rheault P, Giaquinto C, Horn M, Petry KU, Peters K, Azhar T, Hillemanns P, De Simoni S, Friel D, Pemmaraju S, Hezareh M, Thomas F, Descamps D, Folschweiller N, Struyf F. Sustained Immunogenicity of 2-dose Human Papillomavirus 16/18 AS04-adjuvanted Vaccine Schedules in Girls Aged 9-14 Years: A Randomized Trial. J Infect Dis 2017; 215:1711-1719. [PMID: 28591778 PMCID: PMC5853959 DOI: 10.1093/infdis/jix154] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/20/2017] [Indexed: 01/20/2023] Open
Abstract
Background. We previously reported the noninferiority 1 month after the last dose of 2-dose human papillomavirus 16/18 AS04-adjuvanted (AS04-HPV-16/18) vaccine schedules at months 0 and 6 (2D_M0,6) and months 0 and 12 (2D_M0,12) in girls aged 9–14 years compared with a 3-dose schedule at months 0, 1, and 6 (3D_M0,1,6) in women aged 15–25 years. Here, we report the results at study end (month 36 [M36]). Methods. Girls were randomized 1:1 and received 2 vaccine doses either 6 months (2D_M0,6) or 12 months apart (2D_M0,12); women received 3 doses at months 0, 1, and 6 (3D_M0,1,6). Endpoints included noninferiority of HPV-16/18 antibodies for 2D_M0,6 versus 3D_M0,1,6; 2D_M0,12 versus 3D_M0,1,6; and 2D_M0,12 versus 2D_M0,6; and assessment of neutralizing antibodies, T cells, B cells, and safety. Results. At M36, the 2D_M0,6 and 2D_M0,12 schedules remained noninferior to the 3D_M0,1,6 schedule in terms of seroconversion rates and 3D/2D geometric mean titers for anti-HPV-16 and anti-HPV-18. All schedules elicited sustained immune responses up to M36. Conclusions. Both 2-dose schedules in young girls remained noninferior to the 3-dose schedule in women up to study conclusion at M36. The AS04-HPV-16/18 vaccine administered as a 2-dose schedule was immunogenic and well tolerated in young girls.
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Affiliation(s)
- Li-Min Huang
- Department of Pediatrics, National Taiwan University Children's Hospital, National Taiwan University, Taipei
| | - Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, and Research Unit in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Thailand
| | - Chiu Cheng-Hsun
- Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan
| | - Tang Ren-Bin
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tino Schwarz
- Central Laboratory and Vaccination Centre, Klinikum Würzburg Mitte, Standort Juliusspital, Würzburg
| | - Angelo Pellegrino
- Department Distretto di Dronero, Azienda Sanitaria Locale Cuneo 1, Cuneo
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, Milan
| | | | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Dalhousie University, Halifax
| | - Paolo Durando
- Department of Health Sciences, University of Genoa and IRCCS AOU San Martino-IST, Genoa
| | | | - Carlo Giaquinto
- Department of Women's and Children's Health, University of Padova, Padua, Italy
| | | | - Karl Ulrich Petry
- Department of Gynaecology and Obstetrics, Klinikum Wolfsburg, Wolfsburg
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg
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Sharp WMJ, Nadarzynski T, Dufty NE. Time to consider a targeted HPV vaccination programme for male military recruits. J ROY ARMY MED CORPS 2017; 164:284-286. [PMID: 28883023 DOI: 10.1136/jramc-2017-000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 11/03/2022]
Abstract
Human papillomaviruses (HPV) are the most common type of sexually transmitted infection in men but also related to high-risk cancers. This article considers the epidemiology of HPV in the male military population, the UK vaccination programme and the current UK Joint Committee on Vaccination and Immunisation recommendations. Military men may not benefit from HPV herd immunity and may have a different risk profile; vaccination may in turn reduce the operational burden of HPV-related disease within this population. Military men may benefit from a targeted vaccination programme, and the paper calls for urgent consideration of approaches that could protect them from acquiring HPV.
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Affiliation(s)
| | - T Nadarzynski
- Department of Sexual Health Services, Solent NHS Trust, Southampton, UK.,Department of Psychology, University of Southampton, Southampton, UK
| | - N E Dufty
- Department of Sexual Health, Birmingham Heartlands Hospital, Birmingham, UK.,Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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39
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Maver PJ, Poljak M. Progress in prophylactic human papillomavirus (HPV) vaccination in 2016: A literature review. Vaccine 2017; 36:5416-5423. [PMID: 28801154 DOI: 10.1016/j.vaccine.2017.07.113] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 12/25/2022]
Abstract
Prophylactic human papillomavirus (HPV) vaccine represents a revolutionary step forward in preventing HPV-related cancers, especially cervical carcinoma. Alongside appropriate screening, it has the potential to dramatically reduce cervical cancer incidence and even eradicate it. Following extensive evaluations in clinical trials, the first decade of routine HPV vaccine use provides overwhelming evidence of the vaccines' safety and their real-life effectiveness. In 2016, further clinical trials showed high vaccine efficacy in adult women, especially those that were HPV DNA-negative at baseline, and indicated possible protection from HPV-related diseases after treatment of precancerous cervical lesions. The recommendation for a two-dose schedule in individuals under 15 is further supported for all three licensed vaccines by immunogenicity studies that show non-inferior immune responses and similar clinical efficacy compared to the three-dose schedule. So far, natural competition between HPV types has not been confirmed and therefore vaccine-induced clinically significant type replacement is unlikely. The real-world effectiveness data showed cross-sectional reduction in the prevalence/incidence of vaccine-related HPV types, genital warts and precancerous cervical lesions in countries and regions with HPV vaccination coverage. These declines were evident not only in vaccinated females, but also in unvaccinated females and males, strongly suggesting herd protection. Despite an excellent safety profile consistently demonstrated in clinical trials and confirmed in real-life settings, recently invented controversial syndromes allegedly linked to HPV vaccines temporarily compromised some previously very successful vaccination programs and significantly contributed to the failure of HPV vaccine implementation in some countries with the highest prevalence of cervical cancer. However, several safety studies failed to confirm any association of these syndromes with HPV vaccination in various settings and geographic locations. The main challenges remain implementing HPV vaccination in national vaccination programs, especially in low-and middle-income countries with the highest burden of cervical cancer, and achieving and sustaining high vaccine coverage rates.
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Affiliation(s)
- Polona J Maver
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia.
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40
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Tanton C, Mesher D, Beddows S, Soldan K, Clifton S, Panwar K, Field N, Mercer CH, Johnson AM, Sonnenberg P. Human papillomavirus (HPV) in young women in Britain: Population-based evidence of the effectiveness of the bivalent immunisation programme and burden of quadrivalent and 9-valent vaccine types. PAPILLOMAVIRUS RESEARCH 2017. [PMID: 28626810 PMCID: PMC5462921 DOI: 10.1016/j.pvr.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background In 2008, the UK introduced an HPV immunisation programme in girls. Population-based prevalence estimates of bivalent (HPV-16/18), quadrivalent (HPV-6/11/16/18) and 9-valent (HPV-6/11/16/18/31/33/45/52/58) vaccine types, and comparison over time, are needed to monitor impact, evaluate effectiveness and guide decision-making on vaccination strategies. Methods The third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) in 2010-12, tested urine for HPV from 2569 sexually-experienced women aged 16–44. We report type-specific HPV prevalence and compare results with 1798 women in Natsal-2 (1999–2001) using age-adjusted prevalence ratios (APR). Findings In Natsal-3, 4.2% of women aged 16-44y were positive for HPV‐16/18 and 2.9% for HPV-6/11. In 16–20 year olds, 4.5%, 10.8% and 20.7% had at least one bivalent, quadrivalent or 9-valent vaccine type, respectively. Three-dose vaccine coverage was 52.0% in women aged 18-20y. In this age group, HPV-16/18 prevalence was lower in Natsal-3 than Natsal-2 (5.8% vs 11.2%; APR=0.48[95%CI: 0.24–0.93]), however, prevalences of HPV-6/11, HPV-31/33/45 and HPV-52/58 were unchanged. HPV-16/18 prevalence was also unchanged in women aged 21-44y (APR=0.85[0.61–1.19]). Interpretation These probability surveys provide evidence of the impact of the bivalent immunisation programme. Reductions were specific to HPV-16/18 and to the age group eligible for vaccination. However, substantial vaccine-preventable HPV remains.
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Affiliation(s)
- Clare Tanton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - David Mesher
- Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Simon Beddows
- Virus Reference Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Kate Soldan
- Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Soazig Clifton
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK; NatCen Social Research, 35 Northampton Square, London EC1V 0AX, UK.
| | - Kavita Panwar
- Virus Reference Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
| | - Nigel Field
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, Mortimer Market Centre, London WC1E 6JB, UK.
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Hellner K, Dorrell L. Recent advances in understanding and preventing human papillomavirus-related disease. F1000Res 2017; 6:F1000 Faculty Rev-269. [PMID: 28357043 PMCID: PMC5357030 DOI: 10.12688/f1000research.9701.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 12/19/2022] Open
Abstract
High-risk human papillomaviruses (hrHPV) are responsible for anogenital and oropharyngeal cancers, which together account for at least 5% of cancers worldwide. Industrialised nations have benefitted from highly effective screening for the prevention of cervical cancer in recent decades, yet this vital intervention remains inaccessible to millions of women in low- and middle-income countries (LMICs), who bear the greatest burden of HPV disease. While there is an urgent need to increase investment in basic health infrastructure and rollout of prophylactic vaccination, there are now unprecedented opportunities to exploit recent scientific and technological advances in screening and treatment of pre-invasive hrHPV lesions and to adapt them for delivery at scale in resource-limited settings. In addition, non-surgical approaches to the treatment of cervical intraepithelial neoplasia and other hrHPV lesions are showing encouraging results in clinical trials of therapeutic vaccines and antiviral agents. Finally, the use of next-generation sequencing to characterise the vaginal microbial environment is beginning to shed light on host factors that may influence the natural history of HPV infections. In this article, we focus on recent advances in these areas and discuss their potential for impact on HPV disease.
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Affiliation(s)
- Karin Hellner
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Lucy Dorrell
- Nuffield Department of Medicine, University of Oxford, NDM Research Building, Old Road Campus, Headington, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, The Joint Research Office, Block 60, Churchill Hospital, Old Road, Headington, Oxford, UK
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Kost BP, Hofmann J, Stoellnberger S, Bergauer F, Blankenstein T, Alba-Alejandre I, Stein A, Stuckart C, Weizsäcker K, Mylonas I, Mahner S, Gingelmaier A. Prevalence of human papillomavirus infection of the anal canal in women: A prospective analysis of high-risk populations. Oncol Lett 2017; 13:2495-2501. [PMID: 28454426 DOI: 10.3892/ol.2017.5714] [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: 07/19/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022] Open
Abstract
Infection with certain types of human papillomavirus (HPV) has been associated with the development of cervical and anal cancer. Worldwide, the incidence of anal cancer has increased markedly. The present study aimed to evaluate the prevalence of HPV infection of the uterine cervix and anal canal in human immunodeficiency virus (HIV)- and non-HIV-infected risk populations. Cervical and anal HPV swabs and cytology samples were collected from 287 patients at the University Hospital of Munich, Germany between 2011 and 2013. Patients were divided into HIV-negative controls (G1) and two risk groups, including HIV-negative patients with cytological abnormalities of the cervix (G2) and HIV-infected patients (G3). Data, including clinical parameters, were analysed. The risk groups had significantly more positive results for HPV in the anus (71.03 and 83.15% for G2 and G3, respectively), as compared with G1. The predominant HPV genotypes found in the anus were high-risk HPV genotypes, which were significantly correlated with concomittant cervical HPV findings. In the risk groups, a significant association between the cytological findings and HPV detection in the cervix was found, while the results of the anus revealed no significance. The results of the present study suggested that the prevalence of HPV infection in the anal canal of risk populations is high. Furthermore, patients with abnormal cervical cytology results and HIV-infected women, irrespective of their individual cervical findings, may have a risk of concomittant anal high-risk HPV infection. Based on the predominant HPV genotypes found in the study, HPV vaccination could reduce the incidence of anal cancer. Nevertheless, high-risk patients should be intensively screened for anal squamous intraepithelial abnormalities to avoid invasive cancer stages.
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Affiliation(s)
- Bernd P Kost
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Jörg Hofmann
- Institute of Medical Virology, Charité-Universitätsmedizin, D-10117 Berlin, Germany
| | - Susanne Stoellnberger
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Florian Bergauer
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Thomas Blankenstein
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Irene Alba-Alejandre
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Angela Stein
- Institute of Medical Virology, Charité-Universitätsmedizin, D-10117 Berlin, Germany
| | - Claudia Stuckart
- STAT-UP Statistical Consulting and Services, D-80802 Munich, Germany
| | - Katharina Weizsäcker
- Department of Obstetrics and Gynecology, Charité-Universitätsmedizin, D-10117 Berlin, Germany
| | - Ioannis Mylonas
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Sven Mahner
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
| | - Andrea Gingelmaier
- Department of Gynecology and Obstetrics, Ludwig-Maximilian University of Munich, D-80337 Munich, Germany
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Joura EA, Pils S. Vaccines against human papillomavirus infections: protection against cancer, genital warts or both? Clin Microbiol Infect 2017; 22 Suppl 5:S125-S127. [PMID: 28034371 DOI: 10.1016/j.cmi.2016.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022]
Abstract
Since 2006, three vaccines against infections and disease caused by human papillomavirus (HPV) became available in Europe-in 2006 a quadrivalent HPV 6/11/16/18 vaccine, in 2007 a bivalent HPV 16/18 vaccine and in 2015 a nonavalent HPV 6/11/16/18/31/33/45/52/58 vaccine. HPV 16 and 18 are the most oncogenic HPV strains, causing about 70% of cervical and other HPV-related cancers, HPV 6 and 11 cause 85% of all genital warts. The additional types of the polyvalent vaccine account for about 20% of invasive cervical cancer and >35% of pre-cancer. The potential differences between these vaccines caused some debate. All three vaccines give a robust and long-lasting protection against the strains in the various vaccines. The promise of cross-protection against other types (i.e. HPV 31/33/45) and hence a broader cancer protection was not fulfilled because these observations were confounded by the vaccine efficacy against the vaccine types. Furthermore, cross-protection was not consistent over various studies, not durable and not consistently seen in the real world experience. The protection against disease caused by oncogenic HPV strains was not compromised by the protection against low-risk types causing genital warts. The most effective cancer protection to date can be expected by the nonavalent vaccine, data indicate a 97% efficacy against cervical and vulvovaginal pre-cancer caused by these nine HPV types.
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Affiliation(s)
- E A Joura
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Centre, Medical University of Vienna, Austria.
| | - S Pils
- Department of Gynaecology and Obstetrics, Comprehensive Cancer Centre, Medical University of Vienna, Austria
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44
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No evidence for cross-protection of the HPV-16/18 vaccine against HPV-6/11 positivity in female STI clinic visitors. J Infect 2017; 74:393-400. [PMID: 28126492 DOI: 10.1016/j.jinf.2017.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Data from a vaccine trial and from post-vaccine surveillance in the United Kingdom have suggested that the bivalent HPV-16/18 vaccine offers cross-protection against HPV-6/11 and protection against anogenital warts (AGW). We studied the effect of the bivalent vaccine on genital HPV-6/11 positivity and AGW in the Netherlands. METHODS We included all vaccine-eligible women from the PASSYON study, a biennial cross-sectional study among 16- to 24-year-old sexually transmitted infection (STI) clinic attendants. Vaginal self-swabs were analyzed for type specific HPV and AGW were diagnosed at the STI-clinic. Prevalence of HPV-6 and/or HPV-11 and AGW were compared between self-reported vaccinated and unvaccinated women by log-binomial regression analysis, adjusted for demographics and risk behavior. RESULTS Of the 1198 women included, 56% reported to be vaccinated at least once. Relative to unvaccinated women, the adjusted prevalence ratio (PR) for HPV-6/11 was 1.03 (95% confidence interval [CI] 0.74-1.43) for women vaccinated at least once. The crude PR for AGW was 0.67 (95% CI 0.22-2.07) for women vaccinated at least once. Adjustment did not change these results. CONCLUSIONS We observed no cross-protective effect of the bivalent vaccine on genital HPV-6/11 positivity and a non-significant partially protective effect on AGW.
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Mariani L, Preti M, Cristoforoni P, Stigliano CM, Perino A. Overview of the benefits and potential issues of the nonavalent HPV vaccine. Int J Gynaecol Obstet 2017; 136:258-265. [PMID: 28087890 DOI: 10.1002/ijgo.12075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 10/17/2016] [Accepted: 12/01/2016] [Indexed: 12/22/2022]
Abstract
HPV-related diseases affect anogenital and oropharyngeal regions, heavily affecting the psychosexual dimension of both male and female individuals. HPV vaccination programs based on a bivalent or quadrivalent vaccine have opened broad perspectives for primary prevention. A nonavalent HPV vaccine (9vHPV), covering nine genotypes (HPV6, HPV11, HPV16, HPV18, HPV31, HPV33, HPV45, HPV52, and HPV58), might provide further improvement in terms of direct protection. In the present report, efficacy and safety data from 9vHPV vaccine development programs are examined. Efficacy data come from a pivotal trial, which was conducted among women aged 16-26 years randomly assigned to receive either the 9vHPV or the quadrivalent HPV (4vHPV) vaccine. The 9vHPV vaccine was shown to have potential benefits as compared with 4vHPV, increasing the overall estimated rate of prevention to 90% for cervical cancer and up to 80% for precancerous cervical lesions. For all other HPV-related pre-invasive and invasive lesions, 9vHPV showed potentially greater disease reduction, depending on the anatomic region examined. Thus, the 9vHPV vaccine shows clinical potential for the prevention of HPV-related diseases in both sexes. Future adoption of 9vHPV will depend on factors including market price, cost-effectiveness data, use of a two-dose schedule, and safety and efficacy monitoring in real-life programs.
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Affiliation(s)
- Luciano Mariani
- Regina Elena National Cancer Institute, HPV-Unit, Gynecologic Oncology, Rome, Italy
| | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Turin, Italy
| | | | - Carlo M Stigliano
- Unità Ospedaliera Complessa Ginecologia Preventiva, Azienda Sanitaria Provinciale di Cosenza, Castrovillari, Italy
| | - Antonio Perino
- Obstetrics and Gynecology, Ospedali Riuniti Villa Sofia Cervello, University of Palermo, Palermo, Italy
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Moi H. Dårligere vaksine mot humant papillomvirus. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:700. [DOI: 10.4045/tidsskr.17.0313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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47
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Brotherton JML, Zuber PLF, Bloem PJN. Primary Prevention of HPV through Vaccination: Update on the Current Global Status. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0165-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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48
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Quadrivalent vaccine-targeted human papillomavirus genotypes in heterosexual men after the Australian female human papillomavirus vaccination programme: a retrospective observational study. THE LANCET. INFECTIOUS DISEASES 2016; 17:68-77. [PMID: 27282422 DOI: 10.1016/s1473-3099(16)30116-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Australia introduced a national quadrivalent human papillomavirus (4vHPV) vaccination programme for girls and young women in April, 2007. The HPV genotypes targeted by the female vaccine could also affect the protection afforded to heterosexual men. We examined the prevalence of 4vHPV targeted vaccine genotypes and the nine-valent HPV (9vHPV)-targeted vaccines genotypes among sexually active, predominantly unvaccinated heterosexual men from 2004 to 2015. METHODS We did a retrospective, observational study of urine and urethral swab specimens from heterosexual men aged 25 years or younger attending the Melbourne Sexual Health Centre between July 1, 2004, and June 30, 2015, who tested positive for Chlamydia trachomatis. We extracted HPV DNA and used the PapType HPV assay to detect 14 high-risk HPV genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) and two low-risk genotypes (6 and 11). We calculated the prevalence of any HPV genotype, genotypes 6 or 11, genotypes 16 or 18, genotypes in the 4vHPV group (6, 11, 16, or 18), five additional genotypes in the 9vHPV group (31, 33, 45, 52, or 58), and non-vaccine-targeted genotypes (31, 33, 35, 39, 45, 51, 56, 58, 59, 66, or 68). FINDINGS We obtained data between July 1, 2004, and June 30, 2015, and did the data analysis in December, 2015. Of 1764 specimens obtained, we included 1466 in our final analysis (the others were excluded because they had indeterminate results or were duplicates). The prevalence of any HPV genotype and genotypes 31, 33, 45, 52, and 58 did not change from 2004-05 to 2014-15, but we noted reductions in genotypes 6 and 11 (from 12% [95% CI 6-21%], to 3% [1-7%], ptrend=0·008), 16 and 18 (from 13% [95% CI 7-22%] to 3% [1-6%], ptrend<0·0001), and 4vHPV-targeted genotypes (from 22% [95% CI 14-33%] to 6% [3-10%], ptrend<0·0001). Prevalence of non-vaccine-targeted genotypes increased from 16% [95% CI 9-26%] to 22% [17-29%], ptrend<0·0001). In Australian-born men, 4vHPV-targeted genotype prevalence decreased from 11 of 55 [20%, 95% CI 10-33%] to two of 74 [3%, 0-11%], ptrend<0·0001); an even greater decline occurred in Australian-born men aged 21 years or younger (from four of 13 [31%, 95% CI 9-61%] to none of 25; ptrend<0·0001). Genotypes 16 and 18 decreased (adjusted prevalence ratio [PR] 0·32, 95% CI 0·14-0·74; p=0·008) but not genotypes 6 and 11 (adjusted PR 0·50, 0·16-1·56; p=0·234) in the postvaccination period among men who had arrived in Australia within 2 years from countries with a bivalent vaccine (2vHPV) programme (England, Scotland, Wales, Cook Islands, Northern Ireland, or the Netherlands), compared with the prevaccination period. No change was noted in 4vHPV genotypes in men born overseas in other countries. INTERPRETATION The marked reduction in prevalence of 4vHPV genotypes among mainly unvaccinated Australian-born men suggests herd protection has occurred from the female vaccination programme. Additionally, the decline in genotypes 16 and 18, but not genotypes 6 and 11, among overseas-born men predominantly from countries with a 2vHPV vaccine programme suggests that these men received benefits from herd protection for genotypes 16 and 18 from their vaccinated female partners in their own countries. These reductions could translate to reductions in HPV-related malignant conditions in men, even in countries with female-only vaccination programmes. FUNDING The Australian National Health and Medical Research Council Program.
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