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Lehtinen M, Lagheden C, Luostarinen T, Eriksson T, Apter D, Bly A, Gray P, Harjula K, Heikkilä K, Hokkanen M, Karttunen H, Kuortti M, Nieminen P, Nummela M, Paavonen J, Palmroth J, Petäjä T, Pukkala E, Soderlund-Strand A, Veivo U, Dillner J. Human papillomavirus vaccine efficacy against invasive, HPV-positive cancers: population-based follow-up of a cluster-randomised trial. BMJ Open 2021; 11:e050669. [PMID: 35149535 PMCID: PMC8719207 DOI: 10.1136/bmjopen-2021-050669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccination protects against HPV, a necessary risk factor for cervical cancer. We now report results from population-based follow-up of randomised cohorts that vaccination provides HPV-type-specific protection against invasive cancer. METHODS Individually and/or cluster randomised cohorts of HPV-vaccinated and non-vaccinated women were enrolled in 2002-2005. HPV vaccine cohorts comprised originally 16-17 year-old HPV 16/18-vaccinated PATRICIA (NCT00122681) and 012 trial (NCT00169494) participants (2465) and HPV6/11/16/18-vaccinated FUTURE II (NCT00092534) participants (866). Altogether, 3341 vaccines were followed by the Finnish Cancer Registry in the same way as 16 526 non-HPV-vaccinated controls. The control cohort stemmed from 15 665 originally 18-19 years-old women enrolled in 2003 (6499) or 2005 (9166) and 861 placebo recipients of the FUTURE II trial. The follow-up started 6 months after the clinical trials in 2007 and 2009 and ended in 2019. It was age aligned for the cohorts. FINDINGS During a follow-up time of up to 11 years, we identified 17 HPV-positive invasive cancer cases (14 cervical cancers, 1 vaginal cancer, 1 vulvar cancer and 1 tongue cancer) in the non-HPV-vaccinated cohorts and no cases in the HPV-vaccinated cohorts. HPV typing of diagnostic tumour blocks found HPV16 in nine cervical cancer cases, HPV18, HPV33 and HPV52 each in two cases and HPV45 in one cervical cancer case. The vaginal, vulvar and tongue cancer cases were, respectively, positive for HPV16, HPV52/66 and HPV213. Intention-to-treat vaccine efficacy against all HPV-positive cancers was 100% (95% CI 2 to 100, p<0.05). INTERPRETATION Vaccination is effective against invasive HPV-positive cancer. TRIAL REGISTRATION NUMBER NCT00122681, Post-results; NCT00169494, Post-results; NCT00092534, Post-results.
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Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Tampere University Hospital, Tampere, Finland
| | - Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Anne Bly
- Tampere University Hospital, Tampere, Finland
| | - Penelope Gray
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | - Marjo Kuortti
- Faculty of Social Sciences, Tampereen Yliopisto, Tampere, Finland
| | | | | | - J Paavonen
- Department of Gynecology and Obstetrics, University of Helsinki, Helsinki, Finland
| | - Johanna Palmroth
- University of Eastern Finland School of Medicine, Kuopio, Pohjois-Savo, Finland
| | - Tiina Petäjä
- Obstetrics & Gynecology, Tampereen Yliopisto, Seinäjoki, Finland
| | | | | | - Ulla Veivo
- Tampere University Hospital, Tampere, Finland
| | - Joakim Dillner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Lehtinen M, Apter D, Eriksson T, Harjula K, Hokkanen M, Natunen K, Nieminen P, Paavonen J, Palmroth J, Petäjä T, Pukkala E, Vänskä S, Cheuvart B, Soila M, Bi D, Struyf F. Effectiveness of various human papillomavirus vaccination strategies: A community randomized trial in Finland. Cancer Med 2021; 10:7759-7771. [PMID: 34581025 PMCID: PMC8559511 DOI: 10.1002/cam4.4299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION We conducted a community-randomized trial (NCTBLINDED) in Finland to assess gender-neutral and girls-only vaccination strategies with the AS04-adjuvanted human papillomavirus (HPV)-16/18 (AS04-HPV-16/18)vaccine. METHODS Girls and boys (12-15 years) were invited. We randomized 33 communities (1:1:1 ratio): Arm A: 90% of randomly selected girls and boys received AS04-HPV-16/18 vaccine and 10% received hepatitis B vaccine (HBV); Arm B: 90% of randomly selected girls received AS04-HPV-16/18 vaccine, 10% of girls received HBV, and all boys received HBV; Arm C: all participants received HBV. Effectiveness measurements against prevalence of HPV-16/18 cervical infection were estimated in girls at 18.5 years. The main measures were: (1) overall effectiveness comparing Arms A or B, regardless of vaccination status, vs Arm C; (2) total effectiveness comparing AS04-HPV-16/18 vaccinated girls in pooled Arms A/B vs Arm C; (3) indirect effectiveness (herd effect) comparing girls receiving HBV or unvaccinated in Arm A vs Arm C. Co-primary objectives were overall effectiveness following gender-neutral or girls-only vaccination. RESULTS Of 80,272 adolescents invited, 34,412 were enrolled. Overall effectiveness was 23.8% (95% confidence interval: -19.0, 51.1; P = 0.232) with gender-neutral vaccination. Following girls-only vaccination, overall effectiveness was 49.6% (20.1, 68.2; P = 0.004). Total effectiveness was over 90% regardless of vaccination strategy. No herd effect was found. Immunogenicity of the AS04-HPV-16/18 vaccine was high in both sexes. CONCLUSIONS This study illustrates the difficulty in conducting community randomized trials. It is not plausible that vaccinating boys would reduce overall effectiveness, and the apparent lack of herd effect was unexpected given findings from other studies. This analysis was likely confounded by several factors but confirms the vaccine's high total effectiveness as in clinical trials.
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Affiliation(s)
- Matti Lehtinen
- Department of Vaccines, National Institute for Health & Welfare, Helsinki, Finland.,Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Dan Apter
- VL-Medi Clinical Research Center, Helsinki, Finland
| | - Tiina Eriksson
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Katja Harjula
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mari Hokkanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Kari Natunen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Johanna Palmroth
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Petäjä
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Eero Pukkala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Simopekka Vänskä
- Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
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Luntamo T, Korpilahti-Leino T, Ristkari T, Hinkka-Yli-Salomäki S, Kurki M, Sinokki A, Lamminen K, Saanakorpi K, Saarinen S, Maunuksela M, Sourander S, Toivonen K, Zadkova A, Suilamo M, Casagrande L, Palmroth J, Sourander A. Internet-assisted cognitive behavioural therapy with telephone coaching for anxious Finnish children aged 10-13 years: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e045474. [PMID: 34162641 PMCID: PMC8230974 DOI: 10.1136/bmjopen-2020-045474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Childhood anxiety is common, causes significant functional impairment and may lead to psychosocial problems by adulthood. Although cognitive behavioural therapy (CBT) is effective for treating anxiety, its availability is limited by the lack of trained CBT therapists and easily accessible local services. To address the challenges in both recognition and treatment, this study combines systematic anxiety screening in the general population with a randomised controlled trial (RCT) on internet-assisted CBT (ICBT) with telephone coaching. Child, family and intervention-related factors are studied as possible predictors or moderators, together with the COVID-19 pandemic. METHODS AND ANALYSIS The study is an open two-parallel group RCT, stratified by sex, that compares ICBT with telephone coaching to an education control. Children aged 10-13 are screened at yearly school healthcare check-ups using five items from the Screen for Child Anxiety Related Disorders (SCARED) Questionnaire. The families of children who screen positive for anxiety are contacted to assess the family's eligibility for the RCT. The inclusion criteria include scoring at least 22 points in the 41-item SCARED Questionnaire. The primary outcome is the SCARED child and parent reports. The secondary outcomes include the impact of anxiety, quality of life, comorbidity, peer relationships, perceptions of school, parental well-being and service use. Additional measures include demographics and life events, anxiety disorder diagnoses, as well as therapeutic partnerships, the use of the programme and general satisfaction among the intervention group. ETHICS AND DISSEMINATION The study has been approved by the research ethics board of the Hospital District of South West Finland and local authorities. Participation is voluntary and based on informed consent. The anonymity of the participants will be protected and the results will be published in a scientific journal and disseminated to healthcare professionals and the general public. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03310489, pre-results, initially released on 30 September 2017.
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Affiliation(s)
- Terhi Luntamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Tarja Korpilahti-Leino
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Sanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kaisa Lamminen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kristiina Saanakorpi
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Susanna Saarinen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjukka Maunuksela
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Saana Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Katja Toivonen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Anna Zadkova
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Miia Suilamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Linda Casagrande
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Johanna Palmroth
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - A Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
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Gray P, Luostarinen T, Vänskä S, Eriksson T, Lagheden C, Man I, Palmroth J, Pimenoff VN, Söderlund-Strand A, Dillner J, Lehtinen M. Occurrence of human papillomavirus (HPV) type replacement by sexual risk-taking behaviour group: Post-hoc analysis of a community randomized clinical trial up to 9 years after vaccination (IV). Int J Cancer 2019; 145:785-796. [PMID: 30719706 DOI: 10.1002/ijc.32189] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 11/07/2022]
Abstract
Oncogenic non-vaccine human papillomavirus (HPV) types may conceivably fill the vacated ecological niche of the vaccine types. The likelihood of this may differ by the risk of acquiring HPV infections. We examined occurrence of HPV types among vaccinated and unvaccinated subgroups of 1992-1994 birth cohorts with differing acquisition risks up to 9 years post-implementation of HPV vaccination in 33 Finnish communities randomized to: Arm A (gender-neutral HPV16/18 vaccination), Arm B (girls-only HPV16/18 vaccination and hepatitis B-virus (HBV) vaccination of boys), and Arm C (gender-neutral HBV vaccination). Out of 1992-1994 born resident boys (31,117) and girls (30,139), 8,618 boys and 15,615 girls were vaccinated, respectively, with 20-30% and 50% coverage in 2007-2009. In 2010-2013, 8,868 HPV16/18 and non-HPV vaccinated females, and in 2014-2016, 5,574 originally or later (2010-2013) HPV16/18 vaccinated females attended two cervical sampling visits, aged 18.5 and 22-years. The samples were typed for HPV6/11/16/18/31/33/35/39/45/51/52/56/58/59/66/68 using PCR followed by MALDI-TOF MS. HPV prevalence ratios (PR) between Arms A/B vs. C were calculated for Chlamydia trachomatis positives (core-group), and negatives (general population minus core group). At both visits the vaccine-protected HPV type PRs did not significantly differ between the core-group and non-core group. Among the vaccinated 18-year-olds, HPV51 occurrence was overall somewhat increased (PRcore = 1.4, PRnon-core. = 1.4) whereas the HPV52 occurrence was increased in the core-group only (PRcore = 2.5, PRnon-core = 0.8). Among the non-HPV vaccinated 18-year-olds, the HPV51/52 PRs were higher in the core-group (PRcore = 3.8/1.8, PRnon-core = 1.2/1.1). The 22-year-olds yielded no corresponding observations. Monitoring of the sexual risk-taking core-group may detect early tendencies for HPV type replacement.
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Affiliation(s)
- Penelope Gray
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tapio Luostarinen
- Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, Finland
| | - Simopekka Vänskä
- Infectious Disease Control and Vaccinations, Institute of Health and Welfare, Helsinki, Finland
| | - Tiina Eriksson
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Irene Man
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Johanna Palmroth
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ville N Pimenoff
- Oncology Data Analytics Program, Bellvitge Biomedical Research Institute (ICO-IDIBELL), Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Hospitalet de Llobregat, Barcelona, Spain
| | | | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Matti Lehtinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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Lehtinen M, Luostarinen T, Vänskä S, Söderlund-Strand A, Eriksson T, Natunen K, Apter D, Baussano I, Harjula K, Hokkanen M, Kuortti M, Palmroth J, Petäjä T, Pukkala E, Rekonen S, Siitari-Mattila M, Surcel HM, Tuomivaara L, Paavonen J, Nieminen P, Dillner J, Dubin G, Garnett G. Gender-neutral vaccination provides improved control of human papillomavirus types 18/31/33/35 through herd immunity: Results of a community randomized trial (III). Int J Cancer 2018; 143:2299-2310. [PMID: 29845626 DOI: 10.1002/ijc.31618] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 01/05/2023]
Abstract
With optimal strategy, human papillomavirus (HPV) vaccines have the potential to control HPV. We have assessed vaccine efficacy (VE), herd effect (HE) of HPV vaccination and overall protective effectiveness (PE) against high-risk HPV infections by HPV type and vaccination strategy in a community-randomized trial using the bivalent HPV16/18 vaccine. We randomized 33 communities to gender-neutral HPV vaccination (Arm A), HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (Arm B) and gender-neutral HBV vaccination (Arm C). Entire 1992-1995 male (40,852) and female (39,420) birth cohorts were invited, and 11,662 males and 20,513 females vaccinated with 20-30% and 45% coverage in 2007-2010. During 2010-2014, 11,396 cervicovaginal samples were collected from 13,545 18.5-year-old attendees. HPV typing was performed by a high-throughput PCR. VE was calculated for HPV vaccinated women and HE for non-HPV-vaccinated women, using the HBV vaccinated, for HE all non-HPV vaccinated, Arm C women as controls. PE was calculated as coverage rate-weighted mean of VE + HE. HPV16/18/45 and 31/33/35 VEs varied between 86-94% and 30-66%, respectively. Only the gender-neutral vaccination provided significant HEs against HPV18 (61%) and HPV31 (72%) in the 1995 birth cohort-increased HEs against HPV33 (39%) and HPV35 (42%) were also observed. Due to the increased HEs, PEs for HPV16/18/45 and HPV31/33/35 were comparable in the gender-neutral arm 1995 birth cohort. High vaccine efficacy against HPV16/18/45 and, gender-neutral vaccination-enforced, herd effect against HPV18/31/33/35 by the bivalent vaccine rapidly provides comparable overall protective effectiveness against six oncogenic HPV types: 16/18/31/33/35/45.
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Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Tapio Luostarinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Simopekka Vänskä
- Helsinki and Oulu, Institute for Health and Welfare, Helsinki, Finland
| | | | - Tiina Eriksson
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Kari Natunen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Iacopo Baussano
- Department of Infections and Cancer, International Agency for Research on Cancer, Lyon, France
| | - Katja Harjula
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Mari Hokkanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Marjo Kuortti
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Johanna Palmroth
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Tiina Petäjä
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Eero Pukkala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Sirpa Rekonen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Heljä-Marja Surcel
- Department of Clinical Microbiology, Skåne University hospital, Lund, Sweden
| | - Leena Tuomivaara
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Gary Dubin
- Takeda Pharmaceuticals International, Zurich, Switzerland
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Lehtinen M, Söderlund-Strand A, Vänskä S, Luostarinen T, Eriksson T, Natunen K, Apter D, Baussano I, Harjula K, Hokkanen M, Kuortti M, Palmroth J, Petäjä T, Pukkala E, Rekonen S, Siitari-Mattila M, Surcel HM, Tuomivaara L, Paavonen J, Dillner J, Dubin G, Garnett G. Impact of gender-neutral or girls-only vaccination against human papillomavirus-Results of a community-randomized clinical trial (I). Int J Cancer 2018; 142:949-958. [PMID: 29055031 DOI: 10.1002/ijc.31119] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/08/2017] [Accepted: 09/25/2017] [Indexed: 01/03/2023]
Abstract
Human papillomavirus (HPV) vaccine is efficacious but the real-life effectiveness of gender-neutral and girls-only vaccination strategies is unknown. We report a community-randomized trial on the protective effectiveness [(PE) = vaccine efficacy (VE) + herd effect (HE)] of the two strategies among females in virtually HPV vaccination naïve population. We randomized 33 Finnish communities into Arm A) gender-neutral vaccination with AS04-adjuvanted HPV16/18 vaccine (11 communities), Arm B) HPV vaccination of girls and hepatitis B-virus (HBV) vaccination of boys (11 communities) or Arm C) gender-neutral HBV vaccination (11 communities). All resident 39,420 females and 40,852 males born 1992-95 were invited in 2007-09. Virtually all (99%) 12- to 15-year-old participating males (11,662) and females (20,513) received three doses resulting in uniform 20-30% male and 50% female vaccination coverage by birth cohort. Four years later (2010-14) 11,396 cervicovaginal samples obtained from 18.5 year-old women were tested for HPV DNA, and prevalence of cervical HPV infections by trial arm and birth cohort was the main outcome measure. VEs against HPV16/18 varied between 89.2% and 95.2% across birth cohorts in arms A and B. The VEs against non-vaccine types consistent with cross-protection were highest in those born 1994-95 for HPV45 (VEA 82.8%; VEB 86.1%) and for HPV31 (VEA 77.6%, VEB 84.6%). The HEs in the non HPV-vaccinated were statistically significant in those born 1994-95 for HPV18 (HEA 51.0%; 95% CI 8.3-73.8, HEB 47.2%; 6.5-70.2) and for HPV31/33 in arm A (HEA 53.7%; 22.1-72.5). For HPV16 and 45 no significant herd effects were detected. PE estimates against HPV16/18 were similar by both strategies (PEA 58.1%; 45.1-69.4; PEB 55.7%; 42.9-66.6). PE estimates against HPV31/33 were higher by the gender-neutral vaccination (PEA 60.5%; 43.6-73.4; PEB 44.5%; 24.9-60.6). In conclusion, while gender-neutral strategy enhanced the effectiveness of HPV vaccination for cross-protected HPV types with low to moderate coverage, high coverage in males appears to be key to providing a substantial public health benefit also to unvaccinated females. Trial registration www.clinicaltrials.gov.com NCT000534638.
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Affiliation(s)
- Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | | | | | - Tapio Luostarinen
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Tiina Eriksson
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Kari Natunen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | - Iacopo Baussano
- Department of Infections and Cancer, International Agency for Research on Cancer, Lyon, France
| | - Katja Harjula
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Mari Hokkanen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Marjo Kuortti
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Johanna Palmroth
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Tiina Petäjä
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Eero Pukkala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Sirpa Rekonen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | | | - Leena Tuomivaara
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Huddinge, Sweden
| | - Gary Dubin
- Takeda Pharmaceuticals International, Switzerland
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Gray P, Palmroth J, Luostarinen T, Apter D, Dubin G, Garnett G, Eriksson T, Natunen K, Merikukka M, Pimenoff V, Söderlund-Strand A, Vänskä S, Paavonen J, Pukkala E, Dillner J, Lehtinen M. Evaluation of HPV type-replacement in unvaccinated and vaccinated adolescent females-Post-hoc
analysis of a community-randomized clinical trial (II). Int J Cancer 2018; 142:2491-2500. [DOI: 10.1002/ijc.31281] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Penelope Gray
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Johanna Palmroth
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Tapio Luostarinen
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
| | | | - Gary Dubin
- Takeda Pharmaceuticals International; Switzerland
| | | | - Tiina Eriksson
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Kari Natunen
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Marko Merikukka
- Department of Vaccines; Institute for Health and Welfare; Laskut Finland
| | - Ville Pimenoff
- Faculty of Social Sciences; University of Tampere; Tampere Finland
- Catalan Institute of Oncology, IDIBELL; Barcelona Spain
| | | | - Simopekka Vänskä
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
- Department of Vaccines; Institute for Health and Welfare; Laskut Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology; University of Helsinki; Helsinki Finland
| | - Eero Pukkala
- Faculty of Social Sciences; University of Tampere; Tampere Finland
| | - Joakim Dillner
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
| | - Matti Lehtinen
- Faculty of Social Sciences; University of Tampere; Tampere Finland
- Department of Laboratory Medicine; Karolinska Institute; Stockholm Sweden
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Lehtinen M, Lagheden C, Luostarinen T, Eriksson T, Apter D, Harjula K, Kuortti M, Natunen K, Palmroth J, Petäjä T, Pukkala E, Siitari-Mattila M, Struyf F, Nieminen P, Paavonen J, Dubin G, Dillner J. Ten-year follow-up of human papillomavirus vaccine efficacy against the most stringent cervical neoplasia end-point-registry-based follow-up of three cohorts from randomized trials. BMJ Open 2017; 7:e015867. [PMID: 28821519 PMCID: PMC5629648 DOI: 10.1136/bmjopen-2017-015867] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Due to long lag time between infection/cancer diagnoses human papillomavirus (HPV) vaccination programs will deliver vaccine efficacy (VE) estimates against cancer end-points late. Cancer registry follow-up of population-based, randomised trial cohorts of vaccinated and unvaccinated women was undertaken for the estimation of VE against cervical intraepithelial neoplasia grade three and invasive cancer (CIN3+). METHODS We report interim results with 98 561 person years of Finnish Cancer Registry -based follow-up of individually and/or cluster randomised cohorts of HPV-16/18 vaccinated and unvaccinated adolescent women enrolled in June 2003/2005, and between May 2004 and April 2005, respectively. The cohorts comprised 15 627 18- to 19-year-old unvaccinated women (NCT01393470), and 2 401 and 64 16- to 17-year-old HPV-16/18 vaccinated women participating the PATRICIA (NCT00122681) and HPV-012 (NCT00169494) trials, respectively. The age-aligned passive follow-up started 6 months after the clinical trials' end. RESULTS During the follow-up of 4.5 to 10 years post enrolment we identified 75 cases of cervical intraepithelial neoplasia grade 3 (CIN3) and 4 cases of invasive cervical cancer (ICC) in the unvaccinated cohort, and 4 CIN3 cases in the HPV-16/18 vaccinated women. Diagnostic blocks were available for HPV typing from 87% of the cases. CIN3+ lesions were detectable in 54 cases. HPV16 was found in 26 of 50 unvaccinated CIN3+ cases, and in 3 CIN3+ cases in the HPV-16/18 vaccinated women. The latter were all baseline positive for cervical HPV16 DNA. Baseline data was not available for the unvaccinated women. Intention-to-treat VE against any CIN3+ was 66% (95% CI 8, 88). CONCLUSIONS Ten years post vaccination the AS04-adjuvanted HPV-16/18 vaccine shows continued efficacy against CIN3+ irrespectively of HPV type. Vaccine efficacy was not observed in baseline HPV16 DNA positive subjects. TRIAL REGISTRATION NUMBER NCT01393470.
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Affiliation(s)
- Matti Lehtinen
- University of Tampere, Tampere, Finland
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Camilla Lagheden
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tapio Luostarinen
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gary Dubin
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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Lehtinen M, Apter D, Dubin G, Kosunen E, Isaksson R, Korpivaara EL, Kyhä-Osterlund L, Lunnas T, Luostarinen T, Niemi L, Palmroth J, Petäjä T, Rekonen S, Salmivesi S, Siitari-Mattila M, Svartsjö S, Tuomivaara L, Vilkki M, Pukkala E, Paavonen J. Enrolment of 22,000 adolescent women to cancer registry follow-up for long-term human papillomavirus vaccine efficacy: guarding against guessing. Int J STD AIDS 2016; 17:517-21. [PMID: 16925896 DOI: 10.1258/095646206778145550] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Human papillomaviruses (HPVs, most notably types 16 and 18) cause cervical carcinoma, the second most common cancer among women. Vaccination of adolescents against HPV16/18 might prevent large proportion of cervical and other anogenital cancers. However, because of ethical reasons this cannot be proven by clinical studies. To determine the long-term vaccine efficacy (VE) of HPV16/18 virus-like-particle (VLP) vaccine against cervical carcinoma in situ (CIS+) and invasive cervical carcinoma, the following three population-based cohorts of adolescent women have been enrolled: (1) women vaccinated with the HPV vaccine; (2) women vaccinated with hepatitis A control vaccine; and (3) unvaccinated control women. These cohorts will be passively followed for cumulative incidence of CIS+ endpoints by population-based cancer registry. Overall 24,046 16- to 17-year-old adolescent women from 18 cities in Finland were invited between May 2004 and June 2005 to participate in a phase III trial with bivalent HPV16/18 VLP vaccine. A total of 58,996 18- to 19-year-old women were invited in May 2005 to participate as unvaccinated controls. Women who reported their willingness to participate in an HPV vaccination trial had they been 1–2 years younger were eligible. Cumulative incidence (CI) of CIS+ in our cohorts over 15 years is approximately 0.45%. VE of 70% against CIS+ with 80% power requires 3357–3189 HPV16/18 vaccine recipients, 3357–3189 other vaccine recipients, and 6714–9567 unvaccinated controls. We have now enrolled 2404 HPV16/18 vaccine recipients, 2404 hepatitis A-vaccine recipients, and 5130 unvaccinated controls. This enrolment in addition to our earlier enrolment in another phase III trial guarantees enough power so that by 2020 we can ultimately provide data on the efficacy of HPV16/18 vaccination against CIS+.
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10
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Castellsagué X, Paavonen J, Jaisamrarn U, Wheeler CM, Skinner SR, Lehtinen M, Naud P, Chow SN, Del Rosario-Raymundo MR, Teixeira JC, Palmroth J, de Carvalho NS, Germar MJV, Peters K, Garland SM, Szarewski A, Poppe WAJ, Romanowski B, Schwarz TF, Tjalma WAA, Bosch FX, Bozonnat MC, Struyf F, Dubin G, Rosillon D, Baril L. Risk of first cervical HPV infection and pre-cancerous lesions after onset of sexual activity: analysis of women in the control arm of the randomized, controlled PATRICIA trial. BMC Infect Dis 2014; 14:551. [PMID: 25927224 PMCID: PMC4251672 DOI: 10.1186/s12879-014-0551-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More information is needed about time between sexual initiation and human papillomavirus (HPV) infection and development of cervical precancer. METHODS The objectives were to investigate the time between first sexual activity and detection of first cervical HPV infection or development of first cervical intraepithelial neoplasia (CIN), and associated factors in women from the double-blind, multinational, 4-year PATRICIA trial. PATRICIA enroled women aged 15-25 years with no more than 6 lifetime sexual partners. Women were randomized 1:1 to the HPV-16/18 AS04-adjuvanted vaccine or to control, but only women from the control arm who began sexual intercourse during the study or within 6 months before enrolment, and had no HPV infection detected before the recorded date of their first sexual intercourse, were included in the present analysis. The time between onset of sexual activity and detection of the first cervical HPV infection or development of the first CIN lesion was analyzed using Kaplan-Meier and univariate and multivariable Cox proportional-hazards models. RESULTS A total of 9337 women were enroled in the control arm of PATRICIA of whom 982 fulfilled the required inclusion criteria for analysis. A cumulative total of 28%, 44%, and 62% of the subjects had HPV infection within 12, 24, and 48 months, respectively. The overall incidence rate was 27.08 per 100 person-years. The most common oncogenic types associated with 6-month persistent infection were HPV-16 (incidence rate: 2.74 per 100 person-years), HPV-51 (2.70), HPV-52 (1.66), HPV-66 (1.14), and HPV-18 (1.09). Increased infection risk was associated with more lifetime sexual partners, being single, Chlamydia trachomatis history, and duration of hormone use. CIN1+ and CIN2+ lesions were most commonly associated with HPV-16, with an overall incidence rate of 1.87 and 1.07 per 100 person-years, respectively. Previous cervical HPV infection was most strongly associated with CIN development. CONCLUSIONS More than 25% of women were infected with HPV within 1 year of beginning sexual activity. Without underestimating the value of vaccination at older ages, our findings emphasize its importance before sexual initiation. TRIAL REGISTRATION clinicaltrials.gov: NCT00122681 .
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Affiliation(s)
- Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Avda. Gran via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland.
| | - Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Cosette M Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| | - S Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, WA and Sydney University Discipline of Paediatrics and Child Health, Children's Hospital Westmead, Sydney, NSW, Australia.
| | - Matti Lehtinen
- University of Tampere, School of Public Health, Tampere, Finland.
| | - Paulo Naud
- Hospital de Clínicas de Porto Alegre, Department of Gynecology & Obstetrics Federal University of Rio Grande do Sul - UFRGS/HCPA, Porto Alegre, Brazil.
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan.
| | | | - Julio C Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Campinas, Sao Paulo, Brazil.
| | - Johanna Palmroth
- Central Hospital of North Carelian, Department of Obstetrics and Gynecology, Joensuu, Finland.
| | - Newton S de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Parana, Brazil.
| | - Maria Julieta V Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippines General Hospital, Manila, Philippines.
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany.
| | - Suzanne M Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Children's Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Willy A J Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Leuven, Belgium.
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
| | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany.
| | - Wiebren A A Tjalma
- Multidisciplinary Breast Clinic and Gynaecological Oncology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium.
| | - F Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d'Oncologia (ICO), IDIBELL, CIBER-ESP, L'Hospitalet de Llobregat, Avda. Gran via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain. .,Network on Cooperative Cancer Research, RTICC, Catalonia, Spain.
| | | | | | - Gary Dubin
- GlaxoSmithKline Vaccines, King of Prussia, PA, USA.
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Jaisamrarn U, Castellsagué X, Garland SM, Naud P, Palmroth J, Del Rosario-Raymundo MR, Wheeler CM, Salmerón J, Chow SN, Apter D, Teixeira JC, Skinner SR, Hedrick J, Szarewski A, Romanowski B, Aoki FY, Schwarz TF, Poppe WAJ, Bosch FX, de Carvalho NS, Germar MJ, Peters K, Paavonen J, Bozonnat MC, Descamps D, Struyf F, Dubin GO, Rosillon D, Baril L. Natural history of progression of HPV infection to cervical lesion or clearance: analysis of the control arm of the large, randomised PATRICIA study. PLoS One 2013; 8:e79260. [PMID: 24260180 PMCID: PMC3834039 DOI: 10.1371/journal.pone.0079260] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/25/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The control arm of PATRICIA (PApilloma TRIal against Cancer In young Adults, NCT00122681) was used to investigate the risk of progression from cervical HPV infection to cervical intraepithelial neoplasia (CIN) or clearance of infection, and associated determinants. METHODS AND FINDINGS Women aged 15-25 years were enrolled. A 6-month persistent HPV infection (6MPI) was defined as detection of the same HPV type at two consecutive evaluations over 6 months and clearance as ≥2 type-specific HPV negative samples taken at two consecutive intervals of approximately 6 months following a positive sample. The primary endpoint was CIN grade 2 or greater (CIN2+) associated with the same HPV type as a 6MPI. Secondary endpoints were CIN1+/CIN3+ associated with the same HPV type as a 6MPI; CIN1+/CIN2+/CIN3+ associated with an infection of any duration; and clearance of infection. The analyses included 4825 women with 16,785 infections (3363 women with 6902 6MPIs). Risk of developing a CIN1+/CIN2+/CIN3+ associated with same HPV type as a 6MPI varied with HPV type and was significantly higher for oncogenic versus non-oncogenic types. Hazard ratios for development of CIN2+ were 10.44 (95% CI: 6.96-15.65), 9.65 (5.97-15.60), 5.68 (3.50-9.21), 5.38 (2.87-10.06) and 3.87 (2.38-6.30) for HPV-16, HPV-33, HPV-31, HPV-45 and HPV-18, respectively. HPV-16 or HPV-33 6MPIs had ~25-fold higher risk for progression to CIN3+. Previous or concomitant HPV infection or CIN1+ associated with a different HPV type increased risk. Of the different oncogenic HPV types, HPV-16 and HPV-31 infections were least likely to clear. CONCLUSIONS Cervical infections with oncogenic HPV types increased the risk of CIN2+ and CIN3+. Previous or concomitant infection or CIN1+ also increased the risk. HPV-16 and HPV-33 have by far the highest risk of progression to CIN3+, and HPV-16 and HPV-31 have the lowest chance of clearance.
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Affiliation(s)
- Unnop Jaisamrarn
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Xavier Castellsagué
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP, L’Hospitalet de Llobregat, Catalonia, Spain
| | - Suzanne M. Garland
- Department of Microbiology and Infectious Diseases, The Royal Women's Hospital, Parkville/Department of Microbiology, The Royal Children's Hospital, Parkville/Murdoch Childrens Research Institute, Parkville/Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Paulo Naud
- Department of Gynecology & Obstetrics, Federal University of Rio Grande do Sul, UFRGS/HCPA - Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Johanna Palmroth
- Central Hospital of North Carelian, Department of Obstetrics and Gynecology, Joensuu, Finland
| | | | - Cosette M. Wheeler
- Departments of Pathology and Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America
| | - Jorge Salmerón
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Morelos, Mexico
| | - Song-Nan Chow
- Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan
| | - Dan Apter
- Family Federation of Finland, Sexual Health Clinic, Helsinki, Finland
| | - Julio C. Teixeira
- Departamento de Tocoginecologia da Unicamp, University of Campinas, Campinas, Sao Paulo, Brazil
| | - S. Rachel Skinner
- Vaccines Trials Group, Telethon Institute for Child Health Research, Perth, Western Australia
- Sydney University Discipline of Paediatrics and Child Health, Children’s Hospital, Westmead, Sydney, New South Wales, Australia
| | - James Hedrick
- Kentucky Pediatric and Adult Research, Bardstown, Kentucky, United States of America
| | - Anne Szarewski
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Barbara Romanowski
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Fred Y. Aoki
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tino F. Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Academic Teaching Hospital of the University of Wuerzburg, Wuerzburg, Germany
| | - Willy A. J. Poppe
- Department of Gynaecology, University Hospital KU Leuven Gasthuisberg, Leuven, Belgium
| | - F. Xavier Bosch
- Unit of Infections and Cancer, Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO), IDIBELL, CIBER-ESP, L’Hospitalet de Llobregat, Catalonia, Spain
- Network on Cooperative Cancer Research, RTICC, Catalonia, Spain
| | - Newton S. de Carvalho
- Department of Gynecology and Obstetrics, Federal University of Paraná, Infectious Diseases in Gynecology and Obstetrics Sector, Curitiba, Parana, Brazil
| | - Maria Julieta Germar
- Department of Obstetrics and Gynaecology, University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Klaus Peters
- Facharzt für Frauenheilkunde und Geburtshilfe, Hamburg, Germany
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Finland
| | | | | | | | - Gary O. Dubin
- GlaxoSmithKline Vaccines, King of Prussia, Pennsylvania, United States of America
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Palmroth J, Merikukka M, Paavonen J, Apter D, Eriksson T, Natunen K, Dubin G, Lehtinen M. Occurrence of vaccine and non-vaccine human papillomavirus types in adolescent Finnish females 4 years post-vaccination. Int J Cancer 2012; 131:2832-8. [DOI: 10.1002/ijc.27586] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/20/2012] [Indexed: 11/10/2022]
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13
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Merikukka M, Kaasila M, Namujju PB, Palmroth J, Kirnbauer R, Paavonen J, Surcel H, Lehtinen M. Differences in incidence and co‐occurrence of vaccine and nonvaccine human papillomavirus types in Finnish population before human papillomavirus mass vaccination suggest competitive advantage for HPV33. Int J Cancer 2010; 128:1114-9. [DOI: 10.1002/ijc.25675] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 07/09/2010] [Indexed: 11/09/2022]
Affiliation(s)
| | - Marjo Kaasila
- National Institute for Health and Welfare, Oulu, Finland
| | | | - Johanna Palmroth
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | | | - Jorma Paavonen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | | | - Matti Lehtinen
- National Institute for Health and Welfare, Oulu, Finland
- School of Public Health, University of Tampere, Tampere, Finland
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Palmroth J, Namujju P, Simen-Kapeu A, Kataja V, Surcel HM, Tuppurainen M, Yliskoski M, Syrjänen K, Lehtinen M. Natural seroconversion to high-risk human papillomaviruses (hrHPVs) is not protective against related HPV genotypes. ACTA ACUST UNITED AC 2010; 42:379-84. [DOI: 10.3109/00365540903501608] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lehtinen M, Idänpään-Heikkilä I, Lunnas T, Palmroth J, Barr E, Cacciatore R, Isaksson R, Kekki M, Koskela P, Kosunen E, Kuortti M, Lahti L, Liljamo T, Luostarinen T, Apter D, Pukkala E, Paavonen J. Population-based enrolment of adolescents in a long-term follow-up trial of human papillomavirus vaccine efficacy. Int J STD AIDS 2006; 17:237-46. [PMID: 16595046 DOI: 10.1258/095646206776253453] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated a study setting for assessment of the long-term vaccine efficacy (VE) of human papillomavirus (HPV) virus-like-particle (VLP) vaccine against cervical carcinoma. A total of 22,412 16- to 17-year old adolescent women from seven cities in Finland were invited by letter to participate in a phase III study of a quadrivalent HPV (types 6, 11, 16, 18) VLP vaccine, between September 2002 and March 2003. A total of 30,947 18-year old women were invited to participate as unvaccinated controls. These women were asked about their willingness to participate in an HPV vaccination trial and to fill a health questionnaire. These three population-based cohorts of adolescent women, including women vaccinated with HPV vaccine or placebo vaccine and unvaccinated control women, are systematically followed over time. The study cohort database will be linked with the Finnish Cancer Registry using cervical carcinoma in situ (CIS) and invasive cervical carcinoma (ICC) as endpoints. Assuming that the cumulative incidence of CIS and ICC over 15 years is 0.45%, and that there is no loss to follow-up, and power of 80%, the determination of 70% total VE will require 3357 HPV vaccine recipients, 3357 placebo vaccine recipients, and 6714 unvaccinated controls. At the baseline, 2632 (12%) of the invited adolescents volunteered to the phase III vaccination trial, and 6790 (22%) responded to the questionnaire study. During a recruitment period of 10 months, 874 HPV vaccine recipients, 875 placebo recipients and 1919 unvaccinated controls were enrolled. Population-based enrollment of large cohorts of vaccinated and unvaccinated adolescents for passive registry-based follow-up with cervical carcinoma as the end-point is feasible and currently going on in Finland.
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Affiliation(s)
- M Lehtinen
- University of Tampere, Helsinki, Finland
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Lehtinen M, Kaasila M, Pasanen K, Patama T, Palmroth J, Laukkanen P, Pukkala E, Koskela P. Seroprevalence atlas of infections with oncogenic and non-oncogenic human papillomaviruses in Finland in the 1980s and 1990s. Int J Cancer 2006; 119:2612-9. [PMID: 16991128 DOI: 10.1002/ijc.22131] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Vaccines against high-risk (hr) human papillomaviruses (HPVs) causing cervical cancer may soon be licensed. Thus, nature of HPV epidemics needs to be studied now. Random sampling for studies on HPV epidemiology was done from all 230,998 women belonging to the population-based Finnish Maternity Cohort and having a minimum of 2 pregnancies between 1983 and 1994. First pregnancy serum specimens were retrieved for 7,805 subjects, and were analyzed for antibodies to HPV6/11, 16 and 18 with standard ELISAs. HPV16 seroprevalence almost doubled from the 1980s to the 1990s, and the epidemic spread to new areas in 23-31 year olds, i.e. the bulk of pregnant female population in the southwest part of the country. The HPV16 epidemic in the 14-22 year olds in 1983-1988 (1961-1974 birth cohorts) and in the 23-31 year olds in 1989-1994 (1958-1971 birth cohorts) overlapped with strong clustering of HPV16 and HPV18 infections in the latter (odds ratio 8.0, 95% confidence interval 6.6-9.7). Similar clustering of HPV16 and HPV6/11 infections was not found. The epidemic and the clustering may be due to high transmission probability of the hrHPV types and increase in sexual activity of the index birth cohorts.
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Affiliation(s)
- Matti Lehtinen
- National Public Health Institute, Oulu and Kuopio, Finland.
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