Open Access
Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis
Mélanie Drolet,Élodie Bénard,Marie-Claude Boily,Hammad Ali,Louise Baandrup,Simon Beddows,Jacques Brisson,Julia M.L. Brotherton,Teresa Cummings,Basil Donovan,Christopher K Fairley,Elaine W. Flagg,Anne M Johnson,Jessica A. Kahn,Kimberley Kavanagh,Susanne K. Kjaer,Erich V. Kliewer,Philippe Lemieux-Mellouki,Lauri E. Markowitz,Aminata Mboup,David Mesher,Linda M. Niccolai,Jeannie Oliphant,Kevin G.J. Pollock,Kate Soldan,Pam Sonnenberg,Sepehr N. Tabrizi,Clare Tanton,Marc Brisson +28 more
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TLDR
A systematic review and meta-analysis to assess the population-level consequences and herd effects after female HPV vaccination programs, to verify whether or not the high efficacy reported in randomised controlled clinical trials are materialising in real-world situations is materializing in realworld situations.Abstract:
BACKGROUND
Human papillomavirus (HPV) vaccination programmes were first implemented in several countries worldwide in 2007. We did a systematic review and meta-analysis to assess the population-level consequences and herd effects after female HPV vaccination programmes, to verify whether or not the high efficacy reported in randomised controlled clinical trials are materialising in real-world situations.
METHODS
We searched the Medline and Embase databases (between Jan 1, 2007 and Feb 28, 2014) and conference abstracts for time-trend studies that analysed changes, between the pre-vaccination and post-vaccination periods, in the incidence or prevalence of at least one HPV-related endpoint: HPV infection, anogenital warts, and high-grade cervical lesions. We used random-effects models to derive pooled relative risk (RR) estimates. We stratified all analyses by age and sex. We did subgroup analyses by comparing studies according to vaccine type, vaccination coverage, and years since implementation of the vaccination programme. We assessed heterogeneity across studies using I(2) and χ(2) statistics and we did trends analysis to examine the dose-response association between HPV vaccination coverage and each study effect measure.
FINDINGS
We identified 20 eligible studies, which were all undertaken in nine high-income countries and represent more than 140 million person-years of follow-up. In countries with female vaccination coverage of at least 50%, HPV type 16 and 18 infections decreased significantly between the pre-vaccination and post-vaccination periods by 68% (RR 0·32, 95% CI 0·19-0·52) and anogenital warts decreased significantly by 61% (0·39, 0·22-0·71) in girls 13-19 years of age. Significant reductions were also recorded in HPV types 31, 33, and 45 in this age group of girls (RR 0·72, 95% CI 0·54-0·96), which suggests cross-protection. Additionally, significant reductions in anogenital warts were also reported in boys younger than 20 years of age (0·66 [95% CI 0·47-0·91]) and in women 20-39 years of age (0·68 [95% CI 0·51-0·89]), which suggests herd effects. In countries with female vaccination coverage lower than 50%, significant reductions in HPV types 16 and 18 infection (RR 0·50, 95% CI 0·34-0·74]) and in anogenital warts (0·86 [95% CI 0·79-0·94]) occurred in girls younger than 20 years of age, with no indication of cross-protection or herd effects.
INTERPRETATION
Our results are promising for the long-term population-level effects of HPV vaccination programmes. However, continued monitoring is essential to identify any signals of potential waning efficacy or type-replacement.
FUNDING
The Canadian Institutes of Health Research.read more
Citations
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Human Papillomavirus-Associated Cancers - United States, 2008-2012.
Laura Viens,S. Jane Henley,Meg Watson,Lauri E. Markowitz,Cheryll C. Thomas,Trevor D. Thompson,Hilda Razzaghi,Mona Saraiya +7 more
TL;DR: To assess the incidence of HPV-associated cancers, CDC analyzed 2008-2012 high-quality data from the CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results program.
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TL;DR: Among Swedish girls and women 10 to 30 years old, quadrivalent HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer at the population level.
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Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes : updated systematic review and meta-analysis
Mélanie Drolet,Élodie Bénard,Norma Pérez,Marc Brisson,Marc Brisson,Hammad Ali,Marie-Claude Boily,Vincenzo Baldo,Paul Brassard,Julia M.L. Brotherton,Denton Callander,Marta Checchi,Eric P F Chow,Silvia Cocchio,Tina Dalianis,Shelley L Deeks,Christian Dehlendorff,Basil Donovan,Christopher K Fairley,Elaine W. Flagg,Julia W Gargano,Suzanne M. Garland,Nathalie Grün,Bo T. Hansen,Christopher Harrison,Eva Herweijer,Teresa M. Imburgia,Anne M Johnson,Jessica A. Kahn,Kimberley Kavanagh,Susanne K. Kjaer,Erich V. Kliewer,Bette Liu,Dorothy A Machalek,Lauri E. Markowitz,David Mesher,Christian Munk,Linda M. Niccolai,Mari Nygård,Gina Ogilvie,Jeannie Oliphant,Kevin G.J. Pollock,Maria Jesús Purriños-Hermida,Megan Smith,Marc Steben,Anna Söderlund-Strand,Pam Sonnenberg,Pär Sparén,Clare Tanton,Cosette M. Wheeler,Petra J Woestenberg,Bo Nancy Yu +51 more
TL;DR: The 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.
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Epidemiologic Classification of Human Papillomavirus Types Associated with Cervical Cancer
Nubia Muñoz,F. Xavier Bosch,Silvia de Sanjosé,Rolando Herrero,Xavier Castellsagué,Keerti V. Shah,Peter J.F. Snijders,Chris J.L.M. Meijer +7 more
TL;DR: In addition to HPV types 16 and 18, types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82Should be considered carcinogenic, or high-risk, types, and types 26, 53, and 66 should be considered probably carcinogenic.