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Gandelin M, Tran PL, Chirpaz E, Jaffar-Bandjee MC, Traversier N, Machalek D, Bertolotti A. Human Papillomavirus (HPV) Infections Among Participants Undergoing Chlamydia trachomatis Testing in Reunion Island (RUN-SurV-HPV Study): Protocol for a Prevalence Study. JMIR Res Protoc 2023; 12:e47379. [PMID: 37906221 PMCID: PMC10646676 DOI: 10.2196/47379] [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: 05/12/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Infection by human papillomavirus (HPV) induces various cancers, mainly cervical cancer but also anal and pharyngeal cancers. Reunion Island is a French department in the Indian Ocean. Due to the history of its settlement, the island's population has a wide variety of origins, and the population's sociodemographic characteristics differ from those of the French mainland. These characteristics make the island's population an original French population in its own right, particularly in terms of health. Cervical cancer incidence and mortality in Reunion Island are 10.4 per 100,000 and 4.4 per 100,000, respectively, both of which are much higher than those in mainland France. There is also a disparity in the prevalence of different HPV types, with types 33 and 52 being overrepresented and type 18 being underrepresented. However, vaccination and screening coverage in Reunion Island is low. It is important to understand the burden of infection and its risk factors in members of the young Reunionese population at risk of HPV infection to promote and evaluate the implementation of future vaccination and screening programs on a larger scale. OBJECTIVE The RUN-SurV-HPV study will have the following four objectives: (1) to describe the prevalence of HPV genotypes in a population at risk of sexually transmitted infections in Reunion Island; (2) to describe the prevalence of HPV genotypes by anatomical site, gender, and sexuality; (3) to describe the correlates and risk factors for HPV detection; and (4) to examine HPV genotypes between different anatomical sites. METHODS Cross-sectional analyses of 1200 routine vaginal, anal, pharyngeal, and urinary samples collected between October 2020 to December 2022 from female and male patients aged 16 to 30 years undergoing Chlamydia trachomatis testing at a sexually transmitted infection (STI) testing center at Reunion Island will be performed. The population included 333 women who all had vaginal and pharyngeal swabs, with 80 of them also having had an anal swab. There are 167 men who have sex with men who have had anal and pharyngeal swabs, and 120 men who have sex with women who have had a urine swab only. Results will be correlated with sociodemographic and clinical data collected routinely during the consultations. HPV detection and genotyping will be performed using the Anyplex II HPV28 detection assay (Seegene). RESULTS The first polymerase chain reactions should begin in November 2023. The first results should be submitted for publication in 2024. CONCLUSIONS The study will determine HPV prevalence by age, sex, male sexual preference, human immunodeficiency virus status, and STI co-infection. Collecting data from young patients not usually routinely screened for HPV infection will be a simple and reproducible way of better understanding local specificities, encouraging vaccination campaigns in the short-term, and evaluating their effectiveness in the future. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47379.
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Affiliation(s)
- Maxence Gandelin
- Service des Maladies Infectieuses, Dermatologie, Centre Hospitalier Universitaire La Réunion, Saint-Pierre, Réunion
| | - Phuong Lien Tran
- Service de Gynécologie et Obstétrique, Centre Hospitalier Universitaire La Réunion, Saint-Pierre, Réunion
| | - Emmanuel Chirpaz
- Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1410, Centre Hospitalier Universitaire La Réunion, Saint-Pierre, Réunion
- Registre des cancers de La Réunion, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, Réunion
| | | | - Nicolas Traversier
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire La Réunion, Saint Denis, Réunion
| | - Dorothy Machalek
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Centre for Women's Infectious Diseases, The Royal Women's Hospital, Melbourne, Australia
| | - Antoine Bertolotti
- Service des Maladies Infectieuses, Dermatologie, Centre Hospitalier Universitaire La Réunion, Saint-Pierre, Réunion
- Institut National de la Santé et de la Recherche Médicale, Centre d'Investigation Clinique 1410, Centre Hospitalier Universitaire La Réunion, Saint-Pierre, Réunion
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Caruso CR, Yang Z. Molecular diagnostics of infectious disease: Detection and characterization of microbial agents in cytology samples. Diagn Cytopathol 2023; 51:68-82. [PMID: 36263664 DOI: 10.1002/dc.25064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cytology samples are widely used to diagnose various infectious diseases by detection and identification of causative infectious agents, including bacteria, fungi, and viruses. The role of cytopathology in infectious disease has expanded tremendously in the past decades with the advances in molecular techniques. Molecular diagnostic methods, compared to conventional methods, have shown improved patient outcome, reduction in cost, and shortened hospital stay times. The aim of this article is to review molecular testing in cytology samples for diagnosis of infectious diseases. METHODS The literature search for molecular testing in common cytology samples for diagnosis of infectious diseases was performed. The findings of the studies were summarized. The common cytology samples included in this article were gynecologic specimens, cerebrospinal fluid, bronchoalveolar lavage, and urine samples. CONCLUSIONS There are a number of molecular diagnostic tests that are available to be used in common cytology samples to detect infectious agents. Each test has its own advantages and limitations. It is our hope that upon reading this review article, the readers will have better understanding of molecular diagnostic testing of infectious diseases utilizing commonly sampled cytology specimens in daily practice.
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Affiliation(s)
- Carla R Caruso
- Department of Pathology and Anatomic Sciences, University of Missouri, Columbia, Missouri, USA
| | - Zhongbo Yang
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Sun Q, Wang L, Zhang C, Hong Z, Han Z. Cervical cancer heterogeneity: a constant battle against viruses and drugs. Biomark Res 2022; 10:85. [PMCID: PMC9670454 DOI: 10.1186/s40364-022-00428-7] [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: 08/16/2022] [Accepted: 10/30/2022] [Indexed: 11/19/2022] Open
Abstract
Cervical cancer is the first identified human papillomavirus (HPV) associated cancer and the most promising malignancy to be eliminated. However, the ever-changing virus subtypes and acquired multiple drug resistance continue to induce failure of tumor prevention and treatment. The exploration of cervical cancer heterogeneity is the crucial way to achieve effective prevention and precise treatment. Tumor heterogeneity exists in various aspects including the immune clearance of viruses, tumorigenesis, neoplasm recurrence, metastasis and drug resistance. Tumor development and drug resistance are often driven by potential gene amplification and deletion, not only somatic genomic alterations, but also copy number amplifications, histone modification and DNA methylation. Genomic rearrangements may occur by selection effects from chemotherapy or radiotherapy which exhibits genetic intra-tumor heterogeneity in advanced cervical cancers. The combined application of cervical cancer therapeutic vaccine and immune checkpoint inhibitors has become an effective strategy to address the heterogeneity of treatment. In this review, we will integrate classic and recently updated epidemiological data on vaccination rates, screening rates, incidence and mortality of cervical cancer patients worldwide aiming to understand the current situation of disease prevention and control and identify the direction of urgent efforts. Additionally, we will focus on the tumor environment to summarize the conditions of immune clearance and gene integration after different HPV infections and to explore the genomic factors of tumor heterogeneity. Finally, we will make a thorough inquiry into completed and ongoing phase III clinical trials in cervical cancer and summarize molecular mechanisms of drug resistance among chemotherapy, radiotherapy, biotherapy, and immunotherapy.
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Affiliation(s)
- Qian Sun
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Liangliang Wang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Cong Zhang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhenya Hong
- grid.33199.310000 0004 0368 7223Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Zhiqiang Han
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
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Sahlgren HAI, Elfgren K, Sparen P, Elfstrom MK. Colposcopic performance in a birth cohort previously eligible for human papillomavirus vaccination. Am J Obstet Gynecol 2022; 226:704.e1-704.e9. [PMID: 34954217 DOI: 10.1016/j.ajog.2021.11.1372] [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: 07/02/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sweden started subsidized quadrivalent human papillomavirus vaccination for girls aged 13 to 17 in 2007. Since 2012, vaccination has been offered to all girls aged 10 to 12 within a school-based vaccination program, with a coverage of 80% or more. In addition, the vaccine has been offered on-demand as catch-up vaccination for girls aged 13 to 18, with a cumulative coverage of 55% to 60%. Since the first women in Sweden eligible for human papillomavirus vaccination entered the cervical screening program, questions on how to evaluate colposcopic findings among vaccinated women have arisen. Evidence is inconsistent on whether colposcopic features for the detection of cervical lesions are influenced by specific human papillomavirus genotypes and what role they can play in the prevention of invasive cervical cancer in vaccinated women. OBJECTIVE The primary objective of the study was to compare colposcopic evaluation in vaccinated and unvaccinated women entering the organized cervical screening program. STUDY DESIGN Women in the 1994 and 1995 birth cohorts who entered the cervical screening program at age 23 in 1 region in Sweden were identified. Colposcopy was performed within 2 to 4 months after a positive screening result in accordance with national guidelines. Colposcopic performance was evaluated according to national guidelines with the Swede score and colposcopic impression. Punch biopsies were taken from colposcopic lesions and as "random biopsies" in the absence of lesions. These biopsies were used as the gold standard for the analysis. An endocervical sample was analyzed for cytologic findings and detection of 14 high-risk human papillomavirus genotypes. All colposcopic imaging was saved digitally for re-review. Vaccination status was obtained through linkage to national vaccination registries. Results were compared between vaccinated and unvaccinated women. RESULTS In 2018 and 2019, 160 out of 165 (98%) women with a positive screening result attended colposcopy, of which 90 (56%) were vaccinated and 70 (44%) were unvaccinated. Only 7 out of 90 (5%) women in the vaccinated group were human papillomavirus 16/18-positive, compared with 23 out of 70 (33%) in the unvaccinated group (P<.001). There was a total of 61 out of 160 (38%) women with high-grade lesions-33 out of 90 (37%) in the vaccinated group and 28 out of 70 (40%) in the unvaccinated group (P=.697). There was 64% (21/33) of vaccinated women and 75% (21/28) of unvaccinated women with high-grade squamous intraepithelial lesions who had a Swede score of 6 to 10 (indicating high-grade squamous intraepithelial lesions) (P=.124). The sensitivity was slightly higher for the detection of high-grade squamous intraepithelial lesions in unvaccinated women using both colposcopic tests (Swede score, 0.67 vs 0.75; colposcopic impression, 0.67 vs 0.68), but the difference was not statistically significant. CONCLUSION We found no statistically significant difference between the colposcopic evaluation of vaccinated and unvaccinated women, although human papillomavirus vaccination reduced the prevalence of human papillomavirus 16/18 infection in human papillomavirus-vaccinated women. Our results indicate that colposcopic examination is still a useful tool in vaccinated women entering the organized cervical screening program.
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Affiliation(s)
- Hanna A I Sahlgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Obstetrics and Gynecology, Falun Hospital, Falun, Sweden; Regional Cancer Center Uppsala, Uppsala, Sweden.
| | - Kristina Elfgren
- Division of Obstetrics and Gynecology, Department of Clinical Science Intervention and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Miriam K Elfstrom
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
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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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Wang W, Kothari S, Baay M, Garland SM, Giuliano AR, Nygård M, Velicer C, Tota J, Sinha A, Skufca J, Verstraeten T, Sundström K. Real-world impact and effectiveness assessment of the quadrivalent HPV vaccine: a systematic review of study designs and data sources. Expert Rev Vaccines 2021; 21:227-240. [PMID: 34845951 DOI: 10.1080/14760584.2022.2008243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vaccine effectiveness and impact studies are typically observational, generating evidence after vaccine launch in a real-world setting. For human papillomavirus (HPV) vaccination studies, the variety of data sources and methods used is pronounced. Careful selection of study design, data capture and analytical methods can mitigate potential bias in such studies. AREAS COVERED We systematically reviewed the different study designs, methods, and data sources in published evidence (1/2007-3/2020), which assessed the quadrivalent HPV vaccine effectiveness and impact on cervical/cervicovaginal, anal, and oral HPV infections, anogenital warts, lesions in anus, cervix, oropharynx, penis, vagina or vulva, and recurrent respiratory papillomatosis. EXPERT OPINION The rapid growth in access to real-world data allows global monitoring of effects of different public health interventions, including HPV vaccination programs. But the use of data which are not collected or organized to support research also underscore a need to develop robust methodology that provides insight of vaccine effects and consequences of different health policy decisions. To achieve the WHO elimination goal, we foresee a growing need to evaluate HPV vaccination programs globally. A critical appraisal summary of methodology used will provide timely guidance to researchers who want to initiate research activities in various settings.
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Affiliation(s)
- Wei Wang
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Smita Kothari
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | - Suzanne M Garland
- Department Obstetrics and Gynaecology, University of Melbourne, Centre Women's Infectious Diseases Research, Royal Women's Hospital, and Infection & Immunity Murdoch Children's Research Institute, Parkville, Australia
| | - Anna R Giuliano
- Center for Immunizaton and Infection Research in Cancer, Moffitt Cancer Center, Tampa, FL, USA
| | - Mari Nygård
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Christine Velicer
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Joseph Tota
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Anushua Sinha
- Center for Observational and Real-world Evidence, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Jozica Skufca
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
| | | | - Karin Sundström
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
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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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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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Brotherton JML, Wheeler C, Clifford GM, Elfström M, Saville M, Kaldor J, Machalek DA. Surveillance systems for monitoring cervical cancer elimination efforts: Focus on HPV infection, cervical dysplasia, cervical screening and treatment. Prev Med 2021; 144:106293. [PMID: 33075352 PMCID: PMC8403014 DOI: 10.1016/j.ypmed.2020.106293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023]
Abstract
In order to achieve the global elimination of cervical cancer as a public health problem, close surveillance of progress in public health and clinical activities and outcomes across the three pillars of vaccination, screening and treatment will be required. Surveillance should ideally occur within an integrated system that is planned, funded, and regularly evaluated to ensure it is providing timely, accurate and relevant feedback for action. In this paper, we conceptualise the main public health surveillance objectives as process and outcome measures in each of the three pillars. Process measures include coverage/participation measures for vaccination, screening and treatment alongside the ongoing assessment of the quality and reach of these programs and activities. Outcome measures related to the natural history of human papillomavirus (HPV) infection include HPV infection prevalence, precursor cervical lesions and cervical cancers (including stage at diagnosis, cancer incidence and mortality). These outcome measures can be used for monitoring the effectiveness of the three core activities in the short, medium and long term to assess whether these interventions are effectively reducing their occurrence. We discuss possible methods for the surveillance of these measures in the context of country capacity, drawing from examples in Australia, the USA and in low and middle income countries.
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Affiliation(s)
- Julia M L Brotherton
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, Victoria 3002, Australia; Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia.
| | - Cosette Wheeler
- Department of Pathology and Obstetrics & Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Gary M Clifford
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon, Cedex 08, France
| | - Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Alfred Nobels Allé 8, 8th floor, 141 52 Huddinge, Stockholm, Sweden
| | - Marion Saville
- VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, Victoria 3002, Australia; University Department of Obstetrics and Gynaecology, University of Melbourne, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC, 3052, Australia
| | - John Kaldor
- Kirby Institute, Level 6, Wallace Wurth Building, University of New South Wales, High Street, Kensington, NSW 2052, Australia
| | - Dorothy A Machalek
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton 3053, Victoria, Australia; Kirby Institute, Level 6, Wallace Wurth Building, University of New South Wales, High Street, Kensington, NSW 2052, Australia; Centre for Women's Infectious Diseases, The Royal Women's Hospital, Grattan St & Flemington Rd, Parkville, VIC 3052, Australia
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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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Authors' reply. Vaccine 2020; 38:5741. [PMID: 32732067 DOI: 10.1016/j.vaccine.2020.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/31/2019] [Accepted: 01/17/2020] [Indexed: 11/21/2022]
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Gray P, Kann H, Pimenoff VN, Adhikari I, Eriksson T, Surcel HM, Vänskä S, Dillner J, Faust H, Lehtinen M. Long-term follow-up of human papillomavirus type replacement among young pregnant Finnish females before and after a community-randomised HPV vaccination trial with moderate coverage. Int J Cancer 2020; 147:3511-3522. [PMID: 32574384 DOI: 10.1002/ijc.33169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/10/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022]
Abstract
Large scale human papillomavirus (HPV) vaccination against the most oncogenic high-risk human papillomavirus (HPV) types 16/18 is rapidly reducing their incidence. However, attempts at assessing if this leads to an increase of nonvaccine targeted HPV types have been hampered by several limitations, such as the inability to differentiate secular trends. We performed a population-based serological survey of unvaccinated young women over 12 years. The women were under 23-years-old, residents from 33 communities which participated in a community-randomised trial (CRT) with approximately 50% vaccination coverage. Serum samples were retrieved pre-CRT and post-CRT implementation. Seropositivity to 17 HPV types was assessed. HPV seroprevalence ratios (PR) comparing the postvaccination to prevaccination era were estimated by trial arm. This was also assessed among the sexual risk-taking core group, where type replacement may occur more rapidly. In total, 8022 serum samples from the population-based Finnish Maternity Cohort were retrieved. HPV types 16/18 showed decreased seroprevalence among the unvaccinated in communities only after gender-neutral vaccination (PR16/18A = 0.8, 95% CI 0.7-0.9). HPV6/11 and HPV73 were decreased after gender-neutral vaccination (PR6/11A = 0.8, 95% CI 0.7-0.9, PR73A = 0.7, 95% CI 0.6-0.9, respectively) and girls-only vaccination (PR6/11B = 0.8, 95% CI 0.7-0.9, PR73B = 0.9, 95% CI 0.8-1.0). HPV68 alone was increased but only after girls-only vaccination (PR68B = 1.3, 95% CI 1.0-1.7, PRcore68B = 2.8, 95% CI 1.2-6.3). A large-scale, long-term follow-up found no type replacement in the communities with the strongest reduction of vaccine HPV types. Limited evidence for an increase in HPV68 was restricted to girls-only vaccinated communities and may have been due to secular trends (ClinicalTrials.gov number: NCT00534638).
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Affiliation(s)
- Penelope Gray
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Hanna Kann
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ville N Pimenoff
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Finnish Cancer Centre-Mid Finland (FICAN-Mid), Tampere, Finland
| | - Indira Adhikari
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Eriksson
- Research and Development, Tampere University Hospital, Tampere, Finland
| | - Heljä-Marja Surcel
- Faculty of Medicine, University of Oulu, Oulu, Finland
- European Science Infrastructure Services, Oulu, Finland
| | - Simopekka Vänskä
- Department of Infectious Disease Control and Vaccination, Inst. for Health & Welfare, Helsinki, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Faust
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Finnish Cancer Centre-Mid Finland (FICAN-Mid), Tampere, Finland
- Department of Infectious Disease Control and Vaccination, Inst. for Health & Welfare, Helsinki, Finland
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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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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Chen R, Wong E. The feasibility of universal HPV vaccination program in Shenzhen of China: a health policy analysis. BMC Public Health 2019; 19:781. [PMID: 31221112 PMCID: PMC6585043 DOI: 10.1186/s12889-019-7120-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/07/2019] [Indexed: 11/22/2022] Open
Abstract
Background HPV vaccination for the prioritized adolescent girls is well accepted and implemented in developed countries as an effective measure for cervical cancer prevention and control with increasing population-level effectiveness evidence accumulated. This study is to assess the feasibility of universal HPV vaccination among adolescent girls to inform strategies to manage political dimensions of policy-making process in Shenzhen, China, offering insights for other low- and middle-income countries undergoing HPV vaccine introduction. Methods Document review and in-depth interviews with identified stakeholders were conducted. The framework of Health Policy Triangle was adapted to guide data collection and analysis in terms of context, actors, process and content. Stakeholder analysis examining actors’ position, power, role and interest and thematic analysis focusing on data coding and theme development were used. Results Shenzhen’s contextual factors include legislative authority under a unitary political system, economic developments and cultural values on immunization and sexuality. Stakeholders’ position and power could be explained by their role and interest in the Top-down health administration. Mothers could be potential bystanders if having little knowledge on HPV vaccination. Themes in policy-making process were problem definition, advocacy activities to promote HPV vaccination, HPV vaccine demand and access, the role of media and political attention on evidence-informed policy-making in Shenzhen. These stakeholders also discussed different aspects of program planning prospectively. Conclusions Shenzhen witnesses a possibility of demonstration projects for local government’s horizontal accountability but no potential advocates were identified at local level for fragmented organization of public health facilities and health professionals’ lacking mobilization skills. A cervical cancer prevention expert could be a policy entrepreneur. Despite of these challenges, the recommendations to enhance the feasibility include multi-participation to engage non-governmental organizations, pharmaceuticals, target girls and their mothers, power enforcement along governing system, as well as better use of the media.
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Affiliation(s)
- Ruirui Chen
- Baoan Maternal and Child Health Hospital, Jinan University, No. 56 Yulv Road, Shenzhen, China.
| | - Eliza Wong
- School of Public Health and Primary Care, the Chinese University of Hong Kong, Shatin, Hong Kong
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Non-Vaccine-Type Human Papillomavirus Prevalence After Vaccine Introduction: No Evidence for Type Replacement but Evidence for Cross-Protection. Sex Transm Dis 2019; 45:260-265. [PMID: 29465705 DOI: 10.1097/olq.0000000000000731] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined non-vaccine-type human papillomavirus (HPV) prevalence in a community before and during the first 8 years after vaccine introduction, to assess for (1) type replacement with any non-vaccine-type HPV and (2) cross-protection with non-vaccine types genetically related to vaccine-type HPV. METHODS Sexually experienced 13- to- 26-year-old women were recruited for 3 cross-sectional studies from 2006 to 2014 (N = 1180). Outcome variables were as follows: (1) prevalence of at least 1 of 32 anogenital non-vaccine-type HPVs and (2) prevalence of at least 1 HPV type genetically related to HPV-16 and HPV-18. We determined changes in proportions of non-vaccine-type HPV prevalence across the study waves using logistic regression with propensity score inverse probability weighting. RESULTS Vaccine initiation rates increased from 0% to 71.3%. Logistic regression demonstrated that from 2006 to 2014, there was no increase in non-vaccine-type HPV among vaccinated women (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 0.73-1.42), but an increase among unvaccinated women (AOR, 1.88; 95% CI, 1.16-3.04). Conversely, there was a decrease in types genetically related to HPV-16 among vaccinated (AOR, 0.57; 95% CI, 0.38-0.88) but not unvaccinated women (AOR, 1.33; 95% CI, 0.81-2.17). CONCLUSIONS We did not find evidence of type replacement, but did find evidence of cross-protection against types genetically related to HPV-16. These findings have implications for cost-effectiveness analyses, which may impact vaccine-related policies, and provide information to assess the differential risk for cervical cancer in unvaccinated and vaccinated women, which may influence clinical screening recommendations. The findings also have implications for public health programs, such as health messaging for adolescents, parents, and clinicians about HPV vaccination.
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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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Franceschi S, Clifford GM, Baussano I. Options for design of real-world impact studies of single-dose vaccine schedules. Vaccine 2018; 36:4816-4822. [PMID: 29571973 PMCID: PMC6066174 DOI: 10.1016/j.vaccine.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/12/2018] [Accepted: 02/01/2018] [Indexed: 11/25/2022]
Abstract
Based on existing evidence for efficacy, savings, and advantages in delivery, some countries may elect to pilot or roll out single-dose human papillomavirus (HPV) vaccination (instead of, or in combination with, two-dose) in advance of a WHO policy decision. Accelerated evidence of population-based effectiveness (hereafter referred to as overall effectiveness, OE) of one-dose vaccine programs could be gained through regular surveys of HPV prevalence in young women before and after vaccination introduction. In order to offer the earliest information on OE, one-dose HPV vaccination should target one or more birth cohorts as close as possible to the age when sexual activity most often starts in a given population. A catch-up one-dose vaccination program of girls up to 18 years of age who would have been too old to profit from the introduction of a routine HPV vaccination program in preadolescents would minimize the interval between vaccination and the possibility to monitor vaccination impact in young women. In addition, catch-up is especially desirable in low- and middle-income countries with little access to screening as "missed" cohorts may face high risk of cervical cancer death. HPV prevalence should be firstly monitored in age groups of women who may already be sexually active but still reluctant to admit it and to accept vaginal examination for the collection of cervical cells. Hence, HPV testing from urine samples, for which good concordance with cervical cells has been proven, offers a feasible approach to assess periodically vaccine OE in representative samples of 17-20 year-old women. This type of observational study would greatly benefit from the presence of a population census and the creation of a vaccination registry. A real-world demonstration of OE of the new schedule would complement the findings of ongoing clinical trials and immunogenicity studies on the efficacy of single-dose HPV vaccination.
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Affiliation(s)
- Silvia Franceschi
- Cancer Epidemiology Unit, Aviano National Cancer Institute IRCCS, Via Franco Gallini 2, 33081 Aviano (PN), Italy.
| | - Gary M Clifford
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
| | - Iacopo Baussano
- International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France.
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Wolff E, Elfström KM, Haugen Cange H, Larsson S, Englund H, Sparén P, Roth A. Cost-effectiveness of sex-neutral HPV-vaccination in Sweden, accounting for herd-immunity and sexual behaviour. Vaccine 2018; 36:5160-5165. [PMID: 30017146 DOI: 10.1016/j.vaccine.2018.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The aim was to assess cost-effectiveness of expanding the Swedish HPV-vaccination program to include preadolescent boys, by comparing health-effects and costs of HPV-related disease, with a sex-neutral vaccination program versus only vaccinating girls. METHODS We used a dynamic compartmental model to simulate the burden of HPV16/18-related disease in Sweden, accounting for indirect effects of vaccination through herd-immunity. The model accounted for sexual behaviour, such as age preferences and men who have sex with men. The main outcome was number of individuals with HPV-related cancers (cervical, genital, anal and oropharyngeal cancer) and cervical intraepithelial neoplasia (CIN). Costs included in the analysis were those incurred when treating HPV-related cancer and CIN, production losses during sick-leave, and acquisition and administration of vaccine. Health effects were measured as quality-adjusted life years (QALY). The time horizon was set to 100 years, and both effects and costs were discounted by 3% annually. Health effects and costs were accumulated over the time horizon and used to create an incremental cost-effectiveness ratio. RESULTS A sex-neutral vaccination program would reduce HPV-related cancer and CIN, both due to direct effects among vaccinated as well as through herd-immunity, further decreasing HPV-related cancer burden annually by around 60 cases among men and women respectively in steady-state. The cost per gained QALY was estimated to 40,000 euro. Applying the procurement price of 2017, sex-neutral vaccination was dominant. CONCLUSION Introducing a sex-neutral HPV-vaccination program would be good value for money also in Sweden where there this 80% coverage in the current HPV-vaccination program for preadolescent girls. The cost-effectiveness of a sex-neutral program is highly dependent on the price of the vaccine, the lower the price the more favourable it is to also vaccinate boys.
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Affiliation(s)
- Ellen Wolff
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden.
| | - K Miriam Elfström
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden; Regional Cancer Centre of Stockholm-Gotland, Västgötagatan 2, Sweden
| | - Hedda Haugen Cange
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Dept. of Obstetrics and Gynecology, Sahlgrenska University Hospital, Östra, SE 416 85 Gothenburg, Sweden
| | - Sofie Larsson
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Gothenburg University, Institute of Medicine, Medicinaregatan 3, 405 30 Gothenburg, Sweden
| | - Helene Englund
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden
| | - Pär Sparén
- Karolinska Institutet, Stockholm Nobels väg 6, 171 77 Stockholm, Sweden
| | - Adam Roth
- Public Health Agency of Sweden, Nobels väg 18, 171 82 Solna, Sweden; Institution for Translational Medicine, Lund University, J Waldenströms g 35, CRC, hus 92, plan 11, Malmö, Sweden
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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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Dillner J, Nygård M, Munk C, Hortlund M, Hansen BT, Lagheden C, Liaw KL, Kjaer SK. Decline of HPV infections in Scandinavian cervical screening populations after introduction of HPV vaccination programs. Vaccine 2018; 36:3820-3829. [PMID: 29778519 DOI: 10.1016/j.vaccine.2018.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To monitor the changes in prevalence of human papillomavirus (HPV) infections in women <50 years of age, participating in cervical screening programs of Denmark, Norway, and Sweden, before and after introduction of quadrivalent HPV (qHPV) vaccination. METHODS Liquid-based cytology samples were collected from 6538 women who attended cervical screening in Denmark, Norway, and Sweden in 2006-2008 and from 6332 similarly enrolled women in 2012-2013. Denmark started organized qHPV vaccination in 2008, Norway in 2009, and Sweden in 2012. All HPV testing and genotyping was performed using identical enrollment and analysis methods, by accredited general primer polymerase chain reaction methods with typing using the Luminex system. RESULTS Overall HPV positivity declined slightly from 36.5% in 2006-2008 to 34.5% in 2012-2013. The decline was most pronounced among women 18-26 years of age: from 54.4% to 48.1% (P < 0.001). The decline was substantial for vaccine HPV types (HPV6/11/16/18: decline from 22.3% to 16.6%; P < 0.001) and was seen for both low-risk vaccine types (HPV6/11 declined from 5.0% to 2.5%) and high-risk vaccine types (HPV16/18 declined from 18.9% to 14.9%). Among women 27-50 years of age, there was no change between the time periods (22.5% and 21.6%, respectively). The significant decline in the younger age group was different in the 3 countries. CONCLUSION This population-based study enrolling >12,000 women participating in cervical screening in the 3 Nordic countries before and after introduction of organized qHPV vaccination demonstrated a marked decline in HPV infection in the younger population in the 2 countries where qHPV vaccination programs started in 2008-2009, suggesting that organized HPV vaccination programs resulted in a decrease of HPV types circulating in the general population.
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Affiliation(s)
- Joakim Dillner
- WHO HPV LabNet Global Reference Laboratory, Dept. of Clinical Microbiology, Skåne University Hospital, Malmö and Center for Cervical Cancer Prevention, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Mari Nygård
- Dept. of Research, Cancer Registry of Norway, Oslo, Norway
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Hortlund
- WHO HPV LabNet Global Reference Laboratory, Dept. of Clinical Microbiology, Skåne University Hospital, Malmö and Center for Cervical Cancer Prevention, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bo T Hansen
- Dept. of Research, Cancer Registry of Norway, Oslo, Norway
| | - Camilla Lagheden
- WHO HPV LabNet Global Reference Laboratory, Dept. of Clinical Microbiology, Skåne University Hospital, Malmö and Center for Cervical Cancer Prevention, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kai-Li Liaw
- Merck & Co., Inc., Whitehouse Station, NJ, USA
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; Dept. of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
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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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Vänskä S, Söderlund-Strand A, Uhnoo I, Lehtinen M, Dillner J. Estimating effectiveness of HPV vaccination against HPV infection from post-vaccination data in the absence of baseline data. Vaccine 2018; 36:3239-3246. [PMID: 29716776 DOI: 10.1016/j.vaccine.2018.04.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/05/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND HPV vaccination programs have been introduced in large parts of the world, but monitoring of effectiveness is not routinely performed. Many countries introduced vaccination programs without establishing the baseline of HPV prevalences. We developed and validated methods to estimate protective effectiveness (PE) of vaccination from the post-vaccination data alone using references, which are invariant under HPV vaccination. METHODS Type-specific HPV prevalence data for 15-39 year-old women were collected from the pre- and post-vaccination era in a region in southern Sweden. In a region in middle Sweden, where no baseline data had been collected, only post-vaccination data was collected. The age-specific baseline prevalence of vaccine HPV types (vtHPV, HPV 6, 11, 16, 18) were reconstructed as Beta distributions from post-vaccination data by applying the reference odds ratios between the target HPV type and non-vaccine-type HPV (nvtHPV) prevalences. Older non-vaccinated age cohorts and the southern Sweden region were used as the references. The methods for baseline reconstructions were validated by computing the Bhattacharyya coefficient (BC), a measure for divergence, between reconstructed and actual observed prevalences for vaccine HPV types in Southern Sweden, and in addition, for non-vaccine types in both regions. The PE estimates among 18-21 year-old women were validated by comparing the PE estimates that were based on the reconstructed baseline prevalences against the PE estimates based on the actual baseline prevalences. RESULTS In Southern Sweden the PEs against vtHPV were 52.2% (95% CI: 44.9-58.5) using the reconstructed baseline and 49.6% (43.2-55.5) using the actual baseline, with high BC 82.7% between the reconstructed and actual baseline. In the middle Sweden region where baseline data was missing, the PE was estimated at 40.5% (31.6-48.5). CONCLUSIONS Protective effectiveness of HPV vaccination can be estimated from post-vaccination data alone via reconstructing the baseline using non-vaccine HPV type data.
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Affiliation(s)
- Simopekka Vänskä
- National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland; School of Health Sciences, P.O. Box 100, FI-33014 University of Tampere, Finland.
| | | | - Ingrid Uhnoo
- Public Health Agency of Sweden, Nobels väg 18, SE-17182 Stockholm, Sweden.
| | - Matti Lehtinen
- School of Health Sciences, P.O. Box 100, FI-33014 University of Tampere, Finland; Karolinska Institute, Department of Laboratory Medicine, Division of Pathology, F56, SE-14186 Stockholm, Sweden.
| | - Joakim Dillner
- Karolinska Institute, Department of Laboratory Medicine, Division of Pathology, F56, SE-14186 Stockholm, Sweden.
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Final analysis of a study assessing genital human papillomavirus genoprevalence in young Australian women, following eight years of a national vaccination program. Vaccine 2018; 36:3221-3230. [PMID: 29724506 DOI: 10.1016/j.vaccine.2018.04.080] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 04/10/2018] [Accepted: 04/26/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The VACCINE [Vaccine Against Cervical Cancer Impact and Effectiveness] study evaluated the prevalence of quadrivalent vaccine-targeted human papillomavirus (HPV) genotypes (HPV 6, 11, 16, 18) amongst young women of vaccine-eligible age. METHODS Between October 2011 - June 2015, women aged 18-25 years from Victoria, Australia, were recruited through targeted advertising on the social networking website Facebook. Participants completed an online questionnaire and provided a self-collected vaginal swab for HPV DNA detection and genotyping (Linear Array HPV genotyping assay). Self-reported HPV vaccination details were verified with the National HPV Vaccination Program Register (NHVPR). RESULTS Of 1223 who agreed to participate, 916 (74.9%) completed the survey and, for 1007 (82.3%) sexually-active participants, 744 (73.9%) returned the self-collected swab, of which 737 contained detectable DNA. 184/737 (25.0%) were positive for HPV. Vaccine-targeted HPV genotypes were detected in only 13 (1.7%) women: 11 HPV 16 (six vaccinated after sexual debut, five unvaccinated) and two HPV 6. Prevalence of any of HPV 31/33/45 collectively was 2.9%, varying significantly by vaccination status (fully 2.0%, unvaccinated 6.8%; p = 0.01). Vaccination rates among the sexually-active cohort were high, with 65.6%, 71.6% and 74.2% of participants having received three, at least two or at least one dose of vaccine, respectively. Of women self-reporting HPV vaccination, the NHVPR confirmed one or more doses were received in 90%. Strong associations were observed between vaccination status, age, language spoken at home and country of birth, as well as between HPV detection and the number of male sexual partners. CONCLUSION Surveillance five to eight years' post-initiation of a national HPV vaccination program demonstrated a consistent and very low prevalence of vaccine-related HPV genotypes and some evidence of cross protection against related types amongst vaccine-eligible women from Victoria, Australia.
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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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Goggin P, Sauvageau C, Gilca V, Defay F, Lambert G, Mathieu-C S, Guenoun J, Comète E, Coutlée F. Low prevalence of vaccine-type HPV infections in young women following the implementation of a school-based and catch-up vaccination in Quebec, Canada. Hum Vaccin Immunother 2017; 14:118-123. [PMID: 29049007 DOI: 10.1080/21645515.2017.1385688] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In Quebec, Canada, a school-based HPV vaccination for girls has been offered since 2008. The vaccine used in the program targets HPV16/18, responsible for ∼70% of cervical cancers and HPV6/11, responsible for the majority of anogenital warts. The objective of this study was to assess the prevalence of HPV in vaccinated and unvaccinated women. METHODS Women aged 17-29 years were eligible to participate. Participants' age, vaccination status and diverse risk factors were assessed by a computer-assisted questionnaire. Biological specimens were obtained by self-sampling. HPV genotyping was performed by Linear Array. RESULTS A total of 2,118 women were recruited. 2,042 completed the questionnaire and 1,937 provided a vaginal sample. Vaccination coverage varied from 83.5% in women aged 17-19 to 19.1% in those aged 23-29. The overall prevalence of HPV in sexually active women was 39.4% (95%CI: 37.0-41.7) and 56.7% of infected women had multiple type infections. The prevalence of vaccine HPV types varied by age and vaccination status except for women aged 23-29 for whom similar results were observed. Vaccine HPV types were detected in 0.3%, 1.4% and 10.5% of vaccinated women aged 17-19, 20-23, and 23-29 (p<0.05), respectively. HPV16 or HPV18 were detected in 10 women having received at least one dose of vaccine. Nine of these women were already sexually active at the time of vaccination. CONCLUSION Infections with HPV types included in the vaccine are rare in women aged less than 23 years and are virtually absent in those who received at least one dose of vaccine before sexual debut.
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Affiliation(s)
- P Goggin
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - C Sauvageau
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - V Gilca
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,b Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec , Québec , Canada
| | - F Defay
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - G Lambert
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada
| | - S Mathieu-C
- a Direction des Risques Biologiques et de La Santé au Travail, Institut National de Santé Publique du Québec , Montréal and Québec , Québec , Canada.,c Département de Psychopédagogie et D'andragogi, Faculté des Sciences de L'éducation , Université de Montréal , Montréal , Québec , Canada
| | - J Guenoun
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - E Comète
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada
| | - F Coutlée
- d Département de Microbiologie et Infectiologie , Centre hospitalier de l'Université de Montréal , Montréal , Québec , Canada.,e Département de Microbiologie et Immunologie , Université de Montréal , Montréal , Québec , Canada
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Kavanagh K, Pollock KG, Cuschieri K, Palmer T, Cameron RL, Watt C, Bhatia R, Moore C, Cubie H, Cruickshank M, Robertson C. Changes in the prevalence of human papillomavirus following a national bivalent human papillomavirus vaccination programme in Scotland: a 7-year cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2017; 17:1293-1302. [DOI: 10.1016/s1473-3099(17)30468-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023]
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Ding L, Widdice LE, Kahn JA. Differences between vaccinated and unvaccinated women explain increase in non-vaccine-type human papillomavirus in unvaccinated women after vaccine introduction. Vaccine 2017; 35:7217-7221. [PMID: 29169890 DOI: 10.1016/j.vaccine.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/11/2017] [Accepted: 11/03/2017] [Indexed: 01/27/2023]
Abstract
The aim of this study was to determine whether an observed increase in non-vaccine-type human papillomavirus (HPV) in unvaccinated women during the first eight years after vaccine introduction may be explained by differences in demographics or sexual behaviors, instead of type replacement. We analyzed data from three cross-sectional surveillance studies of 13-26 year-old women (total N = 1180). For women recruited from a health department clinic, older age (OR = 1.4, 95% CI: 1.2-1.6) and consistent condom use with main partner in the past 3 months (OR = 11.6, 95% CI: 3.4-40) were associated with being unvaccinated. For women recruited from a teen health center African American race (OR = 0.2, 95% CI: 0.07-0.7) and having Medicaid health insurance (OR = 0.3, 95% CI: 0.1-0.7) were inversely associated with being unvaccinated. The observed increase in non-vaccine-type HPV prevalence in unvaccinated women may be explained by differences between unvaccinated and vaccinated women.
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Affiliation(s)
- Lili Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Lea E Widdice
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jessica A Kahn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; University of Cincinnati College of Medicine, Cincinnati, OH, United States
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College women, HPV genotyping and sexual behavior before HPV vaccination: Results from samples stored for a long time. J Infect Public Health 2017; 11:286-289. [PMID: 28993170 DOI: 10.1016/j.jiph.2017.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 11/21/2022] Open
Abstract
HPV is the sexually transmitted agent most common among young people, like college students. The aim of study was to associate sexual behavior characteristics of women with HPV, detected in genital samples taken before the introduction of the HPV vaccine. Female students during 2001-2005 donated genital samples and the samples were re-analyzed in 2013 for HPV genotyping by RT-PCR. The frozen storage of the students' genital samples allowed the detection of HPV DNA and its genotyping after years of sample collection. HPV prevalence was 22%, HPV16 3.9%, and HPV18 1.1%. Age, multiple sexual partners and the partner's age at first sexual intercourse were significantly associated to HPV. Students with ≥ 3 sexual partners and who did not use condom had 12.8 higher odds of being HPV positive. These results made possible the analysis of HPV prevalence changes, before HPV vaccine introduction.
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Jacqueline C, Tasiemski A, Sorci G, Ujvari B, Maachi F, Missé D, Renaud F, Ewald P, Thomas F, Roche B. Infections and cancer: the "fifty shades of immunity" hypothesis. BMC Cancer 2017; 17:257. [PMID: 28403812 PMCID: PMC5389015 DOI: 10.1186/s12885-017-3234-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/24/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since the beginning of the twentieth century, infection has emerged as a fundamental aspect of cancer causation with a growing number of pathogens recognized as oncogenic. Meanwhile, oncolytic viruses have also attracted considerable interest as possible agents of tumor destruction. DISCUSSION Lost in the dichotomy between oncogenic and oncolytic agents, the indirect influence of infectious organisms on carcinogenesis has been largely unexplored. We describe the various ways - from functional aspects to evolutionary considerations such as modernity mismatches - by which infectious organisms could interfere with oncogenic processes through immunity. Finally, we discuss how acknowledging these interactions might impact public health approaches and suggest new guidelines for therapeutic and preventive strategies both at individual and population levels. Infectious organisms, that are not oncogenic neither oncolytic, may play a significant role in carcinogenesis, suggesting the need to increase our knowledge about immune interactions between infections and cancer.
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Affiliation(s)
- Camille Jacqueline
- CREEC, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- MIVEGEC, UMR IRD/CNRS/UM 5290, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Aurélie Tasiemski
- Unité d’Evolution, Ecologie et Paléontologie (EEP) Université de Lille 1 CNRS UMR 8198, groupe d’Ecoimmunologie des Annélides, 59655 Villeneuve-d’Ascqd’Ascq, France
| | - Gabriele Sorci
- BiogéoSciences, CNRS UMR 6282, Université de Bourgogne Franche-Comté, 6 Boulevard Gabriel, 21000 Dijon, France
| | - Beata Ujvari
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Vic Australia
| | - Fatima Maachi
- Laboratoire de Pathologie Oncologie Digestive, Institut Pasteur 1, Place Abou Kacem Ez-Zahraoui- B.P, 120, Casablanca, Morocco
| | - Dorothée Missé
- CREEC, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- MIVEGEC, UMR IRD/CNRS/UM 5290, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - François Renaud
- CREEC, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- MIVEGEC, UMR IRD/CNRS/UM 5290, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Paul Ewald
- Department of Biology, University of Louisville, Louisville, KY 40292 USA
| | - Frédéric Thomas
- CREEC, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- MIVEGEC, UMR IRD/CNRS/UM 5290, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
| | - Benjamin Roche
- CREEC, 911 Avenue Agropolis, BP 64501, 34394 Montpellier Cedex 5, France
- International Center for Mathematical and Computational Modeling of Complex Systems (UMI IRD/UPMC UMMISCO), 32 Avenue Henri Varagnat, 93143 Bondy Cedex, France
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Jacqueline C, Biro PA, Beckmann C, Moller AP, Renaud F, Sorci G, Tasiemski A, Ujvari B, Thomas F. Cancer: A disease at the crossroads of trade-offs. Evol Appl 2017; 10:215-225. [PMID: 28250806 PMCID: PMC5322410 DOI: 10.1111/eva.12444] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022] Open
Abstract
Central to evolutionary theory is the idea that living organisms face phenotypic and/or genetic trade-offs when allocating resources to competing life-history demands, such as growth, survival, and reproduction. These trade-offs are increasingly considered to be crucial to further our understanding of cancer. First, evidences suggest that neoplastic cells, as any living entities subject to natural selection, are governed by trade-offs such as between survival and proliferation. Second, selection might also have shaped trade-offs at the organismal level, especially regarding protective mechanisms against cancer. Cancer can also emerge as a consequence of additional trade-offs in organisms (e.g., eco-immunological trade-offs). Here, we review the wide range of trade-offs that occur at different scales and their relevance for understanding cancer dynamics. We also discuss how acknowledging these phenomena, in light of human evolutionary history, may suggest new guidelines for preventive and therapeutic strategies.
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Affiliation(s)
- Camille Jacqueline
- CREECMontpellier Cedex 5France
- MIVEGECUMR IRD/CNRS/UM 5290Montpellier Cedex 5France
| | - Peter A. Biro
- Centre for Integrative EcologySchool of Life and Environmental SciencesDeakin UniversityWaurn PondsVICAustralia
| | - Christa Beckmann
- Centre for Integrative EcologySchool of Life and Environmental SciencesDeakin UniversityWaurn PondsVICAustralia
| | - Anders Pape Moller
- Ecologie Systématique EvolutionUniversité Paris‐SudCNRSAgroParisTechUniversité Paris‐Saclay, F‐91405 Orsay CedexFrance
| | - François Renaud
- CREECMontpellier Cedex 5France
- MIVEGECUMR IRD/CNRS/UM 5290Montpellier Cedex 5France
| | - Gabriele Sorci
- BiogéoSciencesCNRS UMR 6282Université de BourgogneDijonFrance
| | - Aurélie Tasiemski
- Unité d'EvolutionEcologie et Paléontologie (EEP) Université de Lille 1 CNRS UMR 8198groupe d'Ecoimmunologie des AnnélidesVilleneuve‐d'AscqFrance
| | - Beata Ujvari
- Centre for Integrative EcologySchool of Life and Environmental SciencesDeakin UniversityWaurn PondsVICAustralia
| | - Frédéric Thomas
- CREECMontpellier Cedex 5France
- MIVEGECUMR IRD/CNRS/UM 5290Montpellier Cedex 5France
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Kahn JA, Widdice LE, Ding L, Huang B, Brown DR, Franco EL, Bernstein DI. Substantial Decline in Vaccine-Type Human Papillomavirus (HPV) Among Vaccinated Young Women During the First 8 Years After HPV Vaccine Introduction in a Community. Clin Infect Dis 2016; 63:1281-1287. [PMID: 27655996 DOI: 10.1093/cid/ciw533] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccine effectiveness and herd protection are not well established in community settings. Our objective was to determine trends in vaccine-type HPV in young women during the 8 years after vaccine introduction, to assess changes in HPV prevalence and characterize herd protection in a community. METHODS We recruited 3 samples of sexually experienced, 13-26-year-old adolescent girls and young women (hereafter women; N = 1180) from 2006-2014: before widespread vaccine introduction (wave 1) and 3 (wave 2) and 7 (wave 3) years after vaccine introduction. We determined the prevalence of vaccine-type HPV (HPV-6, -11, -16, and -18) among all, vaccinated, and unvaccinated women at waves 1, 2, and 3, adjusted for differences in participant characteristics, then examined whether changes in HPV prevalence were significant using inverse propensity score-weighted logistic regression. RESULTS Vaccination rates increased from 0% to 71.3% across the 3 waves. Adjusted vaccine-type HPV prevalence changed from 34.8% to 8.7% (75.0% decline) in all women, from 34.9% to 3.2% (90.8% decline) in vaccinated women, and from 32.5% to 22.0% (32.3% decline) in unvaccinated women. Among vaccinated participants, vaccine-type HPV prevalence decreased significantly from wave 1 to wave 2 (adjusted odds ratio, 0.21; 95% confidence interval, .13-.34) and from wave 1 to wave 3 (0.06; .03-.13). The same decreases were also significant among unvaccinated participants (adjusted odds ratios, 0.44; [95% confidence interval, .27-.71] and 0.59; [.35-.98], respectively). CONCLUSIONS The prevalence of vaccine-type HPV decreased >90% in vaccinated women, demonstrating high effectiveness in a community setting, and >30% in unvaccinated women, providing evidence of herd protection.
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Affiliation(s)
- Jessica A Kahn
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Lea E Widdice
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Lili Ding
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Bin Huang
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
| | - Darron R Brown
- Department of Medicine and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis
| | - Eduardo L Franco
- Department of Oncology and Department of Epidemiology & Biostatistics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - David I Bernstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio
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Hui Y, Hansen K, Murthy J, Chau D, Sung CJ, Quddus MR. Relevance of the Pap Test: A Report of HPV-DNA Test-Negative High-Grade Squamous Intraepithelial Lesions of the Female Lower Genital Tract. Acta Cytol 2016; 60:445-450. [PMID: 27578366 DOI: 10.1159/000448470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/14/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE A vast majority of cervicovaginal intraepithelial lesions are caused by high-risk human papillomaviruses (HPVs). The Pap test has been the sole method used for the screening of cervicovaginal squamous intraepithelial lesions (SIL). Recently, the FDA approved an HPV-DNA assay as a method of primary screening. We report on a series of FDA-approved HPV-DNA test-negative SIL with HPV genotyping, using an alternative method on the corresponding surgical biopsy specimens. STUDY DESIGN A retrospective review identified cytology-positive HPV-negative cases over a 15-month period at a tertiary care gynecologic oncology institution. Corresponding biopsies were reviewed and genotyped for high-risk HPVs. RESULTS Of the 18,200 total cases, 17 patients meeting the study criteria were selected with 27 surgical specimens corresponding to their cytologic diagnoses. Four patients with high-grade lesions were identified, 3 of whom (75%) were positive for HPV. One of these 4 patients (25%) showed high-grade SIL on biopsies from 4 separate sites in the cervix and vagina. Multiviral HPV infections were frequent. CONCLUSIONS We discuss the relevance of cotesting for screening cervical SILs and emphasize that false-negative results are possible with the FDA-approved HPV screening assay, also in patients with high-grade SIL. These cases may be detectable by cytologic examination and this suggests that the Pap test remains an important diagnostic tool.
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Affiliation(s)
- Yiang Hui
- Department of Pathology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, R.I., USA
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Forsner M, Nilsson S, Finnström B, Mörelius E. Expectation prior to human papilloma virus vaccination: 11 to 12-Year-old girls' written narratives. J Child Health Care 2016; 20:365-73. [PMID: 26311482 DOI: 10.1177/1367493515598646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Expectations prior to needle-related procedures can influence individuals' decision making and compliance with immunization programmes. To protect from human papilloma virus (HPV) and cervical cancer, the immunization needs to be given before sexual debut raising interest for this study's aim to investigate how 11 to 12-year-old girls narrate about their expectations prior to HPV vaccination. A total of 27 girls aged 11 to 12 years participated in this qualitative narrative study by writing short narratives describing their expectations. The requirement for inclusion was to have accepted HPV vaccination. Data were subjected to qualitative content analysis. Findings showed the following expectations: going to hurt, going to be scared and going to turn out fine. The expectations were based on the girls' previous experiences, knowledge and self-image. The latent content revealed that the girls tried to transform uneasiness to confidence. The conclusion drawn from this study is that most girls of this age seem confident about their ability to cope with possible unpleasantness related to vaccinations. However, nurses need to find strategies to help those children who feel uneasy about needle-related procedures.
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Affiliation(s)
- M Forsner
- Division of Nursing and Health, School of Education, Health and Social Sciences, Dalarna University, Falun, Sweden
| | - S Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - B Finnström
- Department of Nursing, Health and Culture, University West, Trollhättan, Sweden
| | - E Mörelius
- Division of Activity, Health and Care, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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Lagheden C, Eklund C, Kleppe SN, Unger ER, Dillner J, Sundström K. Validation of a standardized extraction method for formalin-fixed paraffin-embedded tissue samples. J Clin Virol 2016; 80:36-9. [PMID: 27148635 PMCID: PMC5075962 DOI: 10.1016/j.jcv.2016.04.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 04/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Formalin-fixed paraffin-embedded (FFPE) samples can be DNA-extracted and used for human papillomavirus (HPV) genotyping. The xylene-based gold standard for extracting FFPE samples is laborious, suboptimal and involves health hazards for the personnel involved. OBJECTIVES To compare extraction with the standard xylene method to a xylene-free method used in an HPV LabNet Global Reference Laboratory at the Centers for Disease Control (CDC); based on a commercial method with an extra heating step. STUDY DESIGN Fifty FFPE samples were randomly selected from a national audit of all cervical cancer cases diagnosed in Sweden during 10 years. For each case-block, a blank-block was sectioned, as a control for contamination. For xylene extraction, the standard WHO Laboratory Manual protocol was used. For the CDC method, the manufacturers' protocol was followed except for an extra heating step, 120°C for 20min. Samples were extracted and tested in parallel with β-globin real-time PCR, HPV16 real-time PCR and HPV typing using modified general primers (MGP)-PCR and Luminex assays. RESULTS For a valid result the blank-block had to be betaglobin-negative in all tests and the case-block positive for beta-globin. Overall, detection was improved with the heating method and the amount of HPV-positive samples increased from 70% to 86% (p=0.039). For all samples where HPV type concordance could be evaluated, there was 100% type concordance. CONCLUSIONS A xylene-free and robust extraction method for HPV-DNA typing in FFPE material is currently in great demand. Our proposed standardized protocol appears to be generally useful.
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Affiliation(s)
- Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institutet, F56 Huddinge, 14188 Stockholm, Sweden
| | - Carina Eklund
- Department of Laboratory Medicine, Karolinska Institutet, F56 Huddinge, 14188 Stockholm, Sweden
| | - Sara Nordqvist Kleppe
- Department of Laboratory Medicine, Karolinska Institutet, F56 Huddinge, 14188 Stockholm, Sweden
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, F56 Huddinge, 14188 Stockholm, Sweden; Medical Epidemiology & Biostatistics, Karolinska Institutet, SE-17177 Stockholm, Sweden.
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, F56 Huddinge, 14188 Stockholm, Sweden
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Molden T, Feiring B, Ambur OH, Christiansen IK, Hansen M, Laake I, Meisal R, Myrvang E, Jonassen CM, Trogstad L. Human papillomavirus prevalence and type distribution in urine samples from Norwegian women aged 17 and 21 years: A nationwide cross-sectional study of three non-vaccinated birth cohorts. PAPILLOMAVIRUS RESEARCH 2016; 2:153-158. [PMID: 29074174 PMCID: PMC5886875 DOI: 10.1016/j.pvr.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 11/25/2022]
Abstract
Background The aim of the current study was to assess the HPV prevalence in unscreened and unvaccinated young women living in Norway, to provide important baseline data for early estimation of the impact of the HPV vaccination program. Methods A total of 13,129 self-sampled urine samples from two complete birth-cohorts of 17-year old women born in 1994 and 1996 and one third of a birth-cohort of 21-year old women born in 1990, were analysed for the presence of 37 HPV types using PCR and a DNA hybridization technique. Results In the two birth cohorts of 17-year old women, HPV was detected in 19.9% (95% CI 18.8–20.9) and 15.4% (95% CI 14.5–16.3), respectively. High-risk HPV types were detected in 11.2% (95% CI 10.3–12.0) and 7.6% (95% CI 6.9–8.2), respectively, while vaccine types were detected in 7.4% (95% CI 6.7–8.1) and 6.0% (95% CI 5.4–6.6), respectively. Among the 21-year old women HPV was detected in 45.4% (95% CI 42.9–47.8), whereas high-risk types were detected in 29.8% (95% CI 27.5–32.0). Vaccine types (HPV 6, 11, 16, 18) were detected in 16.2% (95% CI 14.4–18.1). Conclusion This large population based study confirms that HPV testing in urine samples is easy and highly feasible for epidemiological studies and vaccine surveillance in young women. HPV was very common and a broad spectrum of HPV types was identified. Differences in HPV prevalence was seen both between age groups and between the two birth cohorts of 17-year old women. Self-sampled urine proved suitable for large scale HPV testing. HPV 16 and 18 was very common among young girls. A wide variety of HPV types circulates in the population. HPV was detected in nearly half of the 21-year old women. HPV was detected in 15–20% of the 17-year old women.
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Affiliation(s)
- Tor Molden
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
| | - Berit Feiring
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
| | - Ole Herman Ambur
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | | | - Mona Hansen
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | - Ida Laake
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
| | - Roger Meisal
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | - Ellen Myrvang
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway.
| | - Christine Monceyron Jonassen
- Akershus University Hospital, PO Box 1000, 1478 Lørenskog, Norway; Østfold Hospital Trust, PO Box 300, 1714 Grålum, Norway.
| | - Lill Trogstad
- Norwegian Institute of Public Health, PO Box, 4404 Nydalen, 0403 Oslo, Norway.
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Abstract
High-risk human papillomaviruses (HPVs) cause essentially all cervical cancers, most anal and oropharyngeal cancers, and some vaginal, vulvar, and penile cancers. Improved understanding of the pathogenesis of infection and the availability of newer tests are changing the approach to screening and diagnosis. Molecular tests to detect DNA from the most common high-risk HPVs are FDA approved for use in conjunction with cytology in cervical cancer screening programs. More-specific tests that detect RNA from high-risk HPV types are now also available. The use of molecular tests as the primary screening tests is being adopted in some areas. Genotyping to identify HPV16 and -18 has a recommended role in triaging patients for colposcopy who are high-risk HPV positive but have normal cytology. There are currently no recommended screening methods for anal, vulvar, vaginal, penile, or oropharyngeal HPV infections. HPV testing has limited utility in patients at high risk for anal cancer, but p16 immunohistochemistry is recommended to clarify lesions in tissue biopsy specimens that show moderate dysplasia or precancer mimics. HPV testing is recommended for oropharyngeal squamous cell tumors as a prognostic indicator. Ongoing research will help to improve the content of future guidelines for screening and diagnostic testing.
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Affiliation(s)
- Eileen M Burd
- Emory University School of Medicine, Department of Pathology and Laboratory Medicine, and Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, USA
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Mesher D, Panwar K, Thomas SL, Beddows S, Soldan K. Continuing reductions in HPV 16/18 in a population with high coverage of bivalent HPV vaccination in England: an ongoing cross-sectional study. BMJ Open 2016; 6:e009915. [PMID: 26868944 PMCID: PMC4762111 DOI: 10.1136/bmjopen-2015-009915] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The human papillomavirus (HPV) immunisation programme in England was introduced in 2008. Monitoring changes in type-specific HPV prevalence allows assessment of the population impact of this vaccination programme. METHODS Residual vulva-vaginal swab specimens were collected from young sexually active women (aged 16-24 years) attending for chlamydia screening across England. Specimens were collected between 2010 and 2013 for type-specific HPV-DNA testing. HPV prevalence was compared to a similar survey conducted in 2008 prior to the introduction of HPV vaccination. RESULTS A total of 7321 specimens collected in the postvaccination period, and 2354 specimens from the prevaccination period were included in this analysis. Among the individuals aged 16-18 years, with an estimated vaccination coverage of 67%, the prevalence of HPV16/18 infection decreased from 17.6% in 2008 to 6.1% in the postvaccination period. Within the postvaccination period, there was a trend towards lower HPV16/18 prevalence with higher vaccination coverage and increasing time since vaccine introduction from 8.5% in the period 2-3 years postvaccination to 4.0% in the period 4-5 years postvaccination. The prevalence of HPV31 reduced from 3.7% in the prevaccination period to 0.9% after vaccine introduction, although this no longer reached statistical significance after additional consideration of the uncertainty due to the assay change. Smaller reductions were seen in the individuals aged 19-21 years with lower estimated vaccination coverage, but there was no evidence of a reduction in the older unvaccinated women. Some overall increase in non-vaccine types was seen in the youngest age groups (ORs (95% CI); 1.3 (1.0 to 1.7) and 1.5 (1.1 to 2.0) for individuals aged 16-18 and 19-21 years, respectively, when adjusted for known population changes and the change in assay) although this should be interpreted with caution given the potential unmasking effect. CONCLUSIONS These data demonstrate a reduction in the HPV vaccine types in the age group with the highest HPV vaccination coverage.
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Affiliation(s)
- David Mesher
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Kavita Panwar
- Virus Reference Department, Public Health England, London, UK
| | - Sara L Thomas
- Department of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, UK
| | - Kate Soldan
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Elfström KM, Lazzarato F, Franceschi S, Dillner J, Baussano I. Human Papillomavirus Vaccination of Boys and Extended Catch-up Vaccination: Effects on the Resilience of Programs. J Infect Dis 2016; 213:199-205. [PMID: 26142436 DOI: 10.1093/infdis/jiv368] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/25/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Decreasing human papillomavirus (HPV) vaccine prices makes scaling up of vaccination programs attractive for countries that initially targeted 1 or a few birth cohorts of girls and/or achieved low coverage. This article aims to compare the impact of alternative HPV vaccination strategies, using data from Sweden, a high-income country that has experienced vaccine price changes. METHODS Using an HPV transmission model, we compared the existing vaccination program to alternatives, accounting for a 1-time catch-up vaccination of 22-26-year-old women, with or without routine vaccination of school-age boys, and for a 1-time catch-up vaccination of males aged 13-26 years. We also assessed the resilience of vaccination alternatives to coverage reduction. RESULTS On the basis of an HPV16/18 prevalence of 12% before the HPV vaccine era, extended catch-up vaccination for females and males yielded relative reductions in the HPV prevalence of 49.4% and 55.6%, respectively, during the first 10 years after the start of each vaccination strategy, whereas the existing program yielded a relative reduction of 38.6% during the same period. The increased prevalence reduction due to catch-up vaccination continued for about 30 years. As compared to female-only routine and extended catch-up vaccination, routine vaccination of males with or without catch-up was, respectively, 12.6-fold and 7.2-fold more resilient to coverage reduction. CONCLUSIONS Vaccination strategies based on catch-up vaccination of females and males are effective for accelerating HPV prevalence reduction. Inclusion of routine male vaccination improves the resilience of vaccination programs.
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Affiliation(s)
| | - Fulvio Lazzarato
- Department of Translational Medicine, University of Piemonte Orientale Avogadro, Novara Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Italy International Agency for Research on Cancer, Lyon, France
| | | | - Joakim Dillner
- Department of Medical Epidemiology and Biostatistics Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Hortlund M, Sundström K, Lamin H, Hjerpe A, Dillner J. Laboratory audit as part of the quality assessment of a primary HPV-screening program. J Clin Virol 2015; 75:33-6. [PMID: 26748032 DOI: 10.1016/j.jcv.2015.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/02/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND As primary HPV screening programs are rolled out, methods are needed for routine quality assurance of HPV laboratory analyzes. OBJECTIVE To explore the use of similar design for audit as currently used in cytology-based screening, to estimate the clinical sensitivity to identify women at risk for CIN 3 or worse (CIN3+). STUDY DESIGN Population-based cohort study conducted within the cervical screening program in Stockholm, Sweden, in 2011-2012. All women with histopathologically confirmed CIN3+ in the following two years were identified by registry analysis. Primary HPV and cytology screening results were collected. For women who had not been HPV tested, biobanked cytology samples were HPV-tested. If the original HPV result had been negative, the sample and subsequent biopsies were analyzed with broad HPV typing (general primer PCR and Luminex). RESULTS 154 women had a biobanked prediagnostic cytology sample taken up to 2 years before a histopathologically confirmed CIN3+. The high-risk HPV-positivity was 97% (148/154 women), whereas 143/154 (94%) women had had a cytological abnormality. Among the six HPV-negative samples, one sample was HPV 33 positive in repeat testing whereas the other five cases were HPV-negative also on repeat testing, but HPV-positive in the subsequent tumor tissue. CONCLUSIONS A sensitivity of the HPV test that is higher than the sensitivity of cytology suggests adequate quality of the testing. Regular audits of clinical sensitivity, similar to those of cytology-based screening, should be used also in HPV-based screening programs, in order to continuously monitor the performance of the analyzes.
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Affiliation(s)
- Maria Hortlund
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Helena Lamin
- Department of Laboratory Medicine, Karolinska University Hospital, Sweden
| | - Anders Hjerpe
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Sweden.
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Abstract
When HPV vaccines were registered in 2006/2007, it was unclear whether these new and type-specific prophylactic vaccines would be accepted by the community for cancer prevention. With an optimal vaccination age of early adolescence, three vaccine doses required, HPV a sexually transmitted infection, and secondary prevention already available in the form of cervical screening, considerable potential challenges were faced. At the time of licensing, vaccine efficacy in males and duration of immunity were not yet unknown. Almost a decade later, with over 230 million doses of the vaccines distributed worldwide and national HPV vaccination programs in place in many countries, it is timely to reflect on current knowledge about the vaccines and some of the lessons learned during implementation.
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Affiliation(s)
- Julia ML Brotherton
- National HPV Vaccination Program Register, VCS Registries, PO Box 310, East Melbourne, Victoria 8002, Australia
- Honorary Principal Fellow, School of Population & Global Health, University of Melbourne, Victoria 3010, Australia
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Human papillomavirus in young women with Chlamydia trachomatis infection 7 years after the Australian human papillomavirus vaccination programme: a cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2015. [PMID: 26201300 DOI: 10.1016/s1473-3099(15)00055-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The national quadrivalent human papillomavirus (4vHPV) vaccination programme was launched in Australia in April, 2007. In this study, we aimed to explore the prevalence of vaccine-targeted human papillomavirus (HPV) types contained in the 4vHPV and nine-valent HPV (9vHPV) vaccines detected in young women diagnosed with chlamydia. METHODS In this cross-sectional study, we identified specimens from women aged 25 years or younger who attended the Melbourne Sexual Health Centre (Melbourne, VIC, Australia) diagnosed with chlamydia. We calculated the prevalence of 4vHPV types (6, 11, 16, and 18) and the extra five 9vHPV types (31, 33, 45, 52, and 58 alone) excluding 4vHPV types, stratified by Australian financial year (and according to the prevaccination and postvaccination periods) and self-reported vaccination status, for all women, Australian-born women, Australian-born women aged 21 years and younger, and overseas-born women. We calculated adjusted prevalence ratios using binomial log linear regression. FINDINGS Between July 1, 2004, and June 30, 2014, we included 1202 women. The prevalence of 4vHPV types in Australian-born women decreased during this period (HPV 6 and 11: 2004-05 nine [16%, 95% CI 8-28] of 56 vs 2013-14 one [2%, 0-9] of 57, p<0·0001; HPV 16 and 18: 17 [30%, 19-44] vs two [4%, 0-12], p<0·0001). In Australian-born women aged 21 years and younger, HPV 6 and 11 prevalence remained at 0% for all years after 2008-09, and we detected HPV 16 and 18 in 5% or less of samples for the same period. In unvaccinated Australian-born women, we noted a significant decrease in 4vHPV types from 66 (41%, 95% CI 34-49) of 160 in the prevaccination period (from July 1, 2004, to June 30, 2007) to five (19%, 6-38) of 27 in the postvaccination period (July 1, 2007, to June 30, 2014; p=0·031), but not in the 9vHPV types, excluding 4vHPV (36 [23%, 95% CI 16-30] vs seven [26%, 11-46]; p=0·805). INTERPRETATION The three-dose vaccination coverage was sufficient for the 4vHPV types to almost disappear in Australian-born women aged 21 years or younger within 3 years of introduction of the national HPV vaccination programme. We noted strong herd protection, with a significant decrease in the prevalence of 4vHPV in unvaccinated women. The 4vHPV vaccination programme in Australia has been successful at protecting women against 4vHPV types. FUNDING Australian National Health and Medical Research Council.
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Near full control of human papillomavirus vaccine types. THE LANCET. INFECTIOUS DISEASES 2015. [PMID: 26201301 DOI: 10.1016/s1473-3099(15)00085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Elfström KM, Dillner J, Arnheim-Dahlström L. Organization and quality of HPV vaccination programs in Europe. Vaccine 2015; 33:1673-81. [DOI: 10.1016/j.vaccine.2015.02.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/29/2015] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
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Söderlund-Strand A, Wikström A, Dillner J. Evaluation of human papillomavirus DNA detection in samples obtained for routine Chlamydia trachomatis screening. J Clin Virol 2015; 64:88-91. [PMID: 25728085 DOI: 10.1016/j.jcv.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/05/2015] [Accepted: 01/10/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The costs and logistics involved in obtaining samples is a bottleneck in large-scale studies of the circulation of human papillomavirus (HPV), which are useful for monitoring and optimisation of HPV-vaccination programs. Residual samples obtained after screening for Chlamydia trachomatis could constitute a convenient, low-cost solution. OBJECTIVES We evaluated HPV DNA detection and typing using (i) the residual samples routinely taken for C. trachomatis screening or (ii) the sample types used in large-scale phase III HPV vaccination trials (cervical, vulvar, labial, perineal, perianal, scrotal and penile shaft samples). STUDY DESIGN Samples from 127 men and 110 women attending two sexual health clinics were analysed using PCR for HPV DNA, with typing using mass spectrometry. RESULTS The HPV DNA prevalence was 7.1% in male urine samples, but 57.3% in female urine/vaginal samples, which was even higher than the HPV prevalence found in cervical samples (54.1%). The sensitivity for HPV DNA detection in the urine/vaginal samples was 7.9% (95% CI 3.0-16.4) for men and 78.9% (95% CI 67.6-87.7) for women, using detection in any one of the reference samples as reference. With cervical samples as reference, the sensitivity was 89.3 % (95% CI 78.1-95.9). CONCLUSIONS Among men, low sensitivity of urine for HPV detection suggests limited usefulness. Among women, the high sensitivity of urine/vaginal samples for HPV detection suggests a useful low-cost solution for the study of HPV epidemiology.
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Affiliation(s)
- Anna Söderlund-Strand
- Division of Laboratory Medicine, Department of Clinical Microbiology, Jan Waldenströms gata 59, 20502 Malmö, Sweden
| | - Arne Wikström
- Department of Dermatovenereology, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, F56Huddinge, 14188 Stockholm, Sweden.
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