1
|
Joshi S, Anantharaman D, Muwonge R, Bhatla N, Panicker G, Butt J, Rani Reddy Poli U, Malvi SG, Esmy PO, Lucas E, Verma Y, Shah A, Zomawia E, Pimple S, Jayant K, Hingmire S, Chiwate A, Divate U, Vashist S, Mishra G, Jadhav R, Siddiqi M, Sankaran S, Pillai Rameshwari Ammal Kannan T, Kartha P, Shastri SS, Sauvaget C, Radhakrishna Pillai M, Waterboer T, Müller M, Sehr P, Unger ER, Sankaranarayanan R, Basu P. Evaluation of immune response to single dose of quadrivalent HPV vaccine at 10-year post-vaccination. Vaccine 2023; 41:236-245. [PMID: 36446654 PMCID: PMC9792650 DOI: 10.1016/j.vaccine.2022.11.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/02/2022] [Accepted: 11/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The recent World Health Organization recommendation supporting single-dose of HPV vaccine will significantly reduce programmatic cost, mitigate the supply shortage, and simplify logistics, thus allowing more low- and middle-income countries to introduce the vaccine. From a programmatic perspective the durability of protection offered by a single-dose will be a key consideration. The primary objectives of the present study were to determine whether recipients of a single-dose of quadrivalent HPV vaccine had sustained immune response against targeted HPV types (HPV 6,11,16,18) at 10 years post-vaccination and whether this response was superior to the natural antibody titres observed in unvaccinated women. METHODS Participants received at age 10-18 years either one, two or three doses of the quadrivalent HPV vaccine. Serology samples were obtained at different timepoints up to 10 years after vaccination from a convenience sample of vaccinated participants and from age-matched unvaccinated women at one timepoint. The evolution of the binding and neutralizing antibody response was presented by dose received. 10-year durability of immune responses induced by a single-dose was compared to that after three doses of the vaccine and in unvaccinated married women. RESULTS The dynamics of antibody response among the single-dose recipients observed over 120 months show stabilized levels 18 months after vaccination for all four HPV types. Although the HPV type-specific (binding or neutralizing) antibody titres after a single-dose were significantly inferior to those after three doses of the vaccine (lower bounds of GMT ratios < 0.5), they were all significantly higher than those observed in unvaccinated women following natural infections (GMT ratios: 2.05 to 4.04-fold higher). The results correlate well with the high vaccine efficacy of single-dose against persistent HPV 16/18 infections reported by us earlier at 10-years post-vaccination. CONCLUSION Our study demonstrates the high and durable immune response in single-dose recipients of HPV vaccine at 10-years post vaccination.
Collapse
Affiliation(s)
- Smita Joshi
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune 411 001, India
| | - Devasena Anantharaman
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram 695 014, Kerala, India
| | - Richard Muwonge
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Neerja Bhatla
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Gitika Panicker
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, USA
| | - Julia Butt
- Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | | | - Sylla G Malvi
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District Solapur, Maharashtra 413 401, India
| | - Pulikkottil O Esmy
- Christian Fellowship Community Health Centre, Ambillikai (near Oddanchathram), Dindigul District, Tamil Nadu 624 612, India
| | - Eric Lucas
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Yogesh Verma
- Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim 737102, India
| | - Anand Shah
- Gujarat Cancer & Research Institute (GCRI), M.P. Shah Cancer Hospital, Civil Hospital Campus, Asarwa, Ahmedabad 380 016, India
| | | | - Sharmila Pimple
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Kasturi Jayant
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District Solapur, Maharashtra 413 401, India
| | - Sanjay Hingmire
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District Solapur, Maharashtra 413 401, India
| | - Aruna Chiwate
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi District Solapur, Maharashtra 413 401, India
| | - Uma Divate
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune 411 001, India
| | - Shachi Vashist
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Gauravi Mishra
- Department of Preventive Oncology, Centre for Cancer Epidemiology (CCE), Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Radhika Jadhav
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune 411 001, India
| | - Maqsood Siddiqi
- Cancer Foundation of India, Kolkata, West Bengal 700 039, India
| | - Subha Sankaran
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram 695 014, Kerala, India
| | | | - Purnima Kartha
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram 695 014, Kerala, India
| | - Surendra S Shastri
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, University of Texas M.D. Anderson Cancer Centre, 1400 Pressler St, Houston, TX 77030-3906, United States
| | - Catherine Sauvaget
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - M Radhakrishna Pillai
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram 695 014, Kerala, India
| | - Tim Waterboer
- Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Martin Müller
- Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, D-69120 Heidelberg, Germany
| | - Peter Sehr
- EMBL-DKFZ Chemical Biology Core Facility, European Molecular Biology Laboratory, D-69117 Heidelberg, Germany
| | - Elizabeth R Unger
- National Center for Emerging and Zoonotic Infectious Diseases, CDC, USA
| | - Rengaswamy Sankaranarayanan
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France; Karkinos Healthcare, Kerala Operations, Ernakulam, India
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France.
| |
Collapse
|
2
|
Immunogenicity and safety of a bivalent, adjuvant system 04-adjuvanted human papillomavirus vaccine in healthy female volunteers aged 15-25: a randomized, double-blind, phase III, noninferiority clinical trial. Eur J Cancer Prev 2022; 31:558-567. [PMID: 35352698 DOI: 10.1097/cej.0000000000000753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Vaccination is proven to significantly reduce the risk of human papillomavirus (HPV)-related complications, especially cervical cancer. This study aimed to assess the immunogenicity and safety of the investigational bivalent HPV vaccine (16/18), named Papilloguard (Noyan Pajouhan Biopharma, Tehran, Iran), in comparison with the reference product (Cervarix, bivalent HPV vaccine (16/18) manufactured by GlaxoSmithKline, Rixensart, Belgium) in a three-dose regimen. METHODS This trial was a randomized, controlled, double-blind, phase III study of two HPV vaccines in healthy female volunteers aged 15-25. The primary endpoint was to test the noninferiority of Papilloguard (Noyan Pajouhan Biopharma) to Cervarix (GlaxoSmithKline) as measured by the geometric mean titer (GMT) ratios of HPV-16 and HPV-18 7 months after the first vaccination. Secondary endpoints were the proportion of local and systemic solicited and unsolicited events, and the number of females with seroconversion against HPV-16 and HPV-18 7 months after the first vaccination. RESULTS Out of 504 screened women, 218 were enrolled. Seven months after the first vaccination, GMT ratios of HPV-16 and HPV-18 were 0.59 and 0.93, respectively. The seroconversion rates of both Papilloguard (Noyan Pajouhan Biopharma) and Cervarix (GlaxoSmithKline) were more than 96%. Both vaccinated groups had a generally good profile of solicited and unsolicited adverse events (AEs). The most common AE was discomfort at the injection site, which was well tolerated. CONCLUSION The result analysis of this study supports the noninferiority of Papilloguard (Noyan Pajouhan Biopharma) to Cervarix (GlaxoSmithKline) in terms of safety and immunogenicity based on the GMT ratio. However, long-term comparative studies to evaluate the sustainability of GMT response and risk of cervical intraepithelial neoplasia grades 2-3 are needed.
Collapse
|
3
|
Affiliation(s)
- Anna Wald
- Department of Medicine, Epidemiology, and Laboratory Medicine & Pathology, University of Washington, Seattle
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
4
|
Collins-Fairclough A, Donken R, Nosyk B, Dobson S, Ogilivie G, Sadarangani M. Non-inferior antibody levels for HPV16/18 after extended two-dose schedules compared with a six-month interval: findings of a systematic review and meta-analysis. Hum Vaccin Immunother 2021; 17:3554-3561. [PMID: 34187301 DOI: 10.1080/21645515.2021.1926182] [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: 10/21/2022] Open
Abstract
Protection after human papillomavirus (HPV) vaccination can be maximized by optimizing vaccination schedules. We systematically reviewed immunogenicity and effectiveness of HPV vaccines administered 6 months apart compared with longer intervals. Seroconversion to vaccine-type HPV was non-inferior for 12- compared with 6-month intervals, but inconclusive for comparison of 36-96 months with 6 months. A 12-month interval showed non-inferior (margin 0.5) vaccine-type HPV antibody responses compared with a 6-month interval. Compared to 6 months, an interval of 36-96 months resulted in non-inferior antibody responses for HPV6 and high-risk types HPV16 and 18, but did not lead to a non-inferior antibody response for HPV11 (GMR 0.63, 95% CI:0.41-0.97). Data on the effectiveness of extended two-dose schedules were limited. Our findings indicate that HPV immunization programs could adopt a 12-month interval instead of 6 months for increased flexibility without compromising immunogenicity. Further evaluation to confirm the immunogenicity and effectiveness of intervals beyond 12 months is warranted.
Collapse
Affiliation(s)
- Aneisha Collins-Fairclough
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.,Faculty of Science and Sport, University of Technology Jamaica, Kingston, Jamaica
| | - Robine Donken
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Women's Health Research Institute, BC Women's Hospital and Health Center, Vancouver, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Simon Dobson
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Gina Ogilivie
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Women's Health Research Institute, BC Women's Hospital and Health Center, Vancouver, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
5
|
Teppler H, Bautista O, Flores S, McCauley J, Luxembourg A. Design of a Phase III immunogenicity and safety study evaluating two-dose regimens of 9-valent human papillomavirus (9vHPV) vaccine with extended dosing intervals. Contemp Clin Trials 2021; 105:106403. [PMID: 33857679 DOI: 10.1016/j.cct.2021.106403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
HPV vaccines are widely licensed as two-dose regimens, 6-12 months apart, for adolescents. Extended intervals between doses may be necessary due to resource constraints or vaccination program disruption. This international, multicenter, open-label study (NCT04708041) will evaluate the safety and immunogenicity of two-dose 9vHPV vaccine regimens with extended intervals of 1-5 years between doses in boys/girls compared with a standard three-dose regimen in women. Participants (planned N = 700) will be enrolled into six cohorts; Cohort 0: boys/girls aged 10-15 years who received one 9vHPV vaccine dose ≥1 year before enrollment without completing the series will receive one study dose of 9vHPV vaccine at day 1; Cohorts 1-4: HPV vaccination-naïve boys/girls aged 9-14 years will receive two doses (day 1 and month 12, 24, 36, or 60); Cohort 5: HPV vaccination-naïve women aged 16-26 years will receive three doses (day 1, months 2 and 6). Primary analyses will be based on serological responses 1 month after final vaccine dose. Co-primary objectives will (1) evaluate non-inferiority of geometric mean titers in each of Cohorts 1-4 versus Cohort 5, and (2) characterize antibody responses in Cohort 0, accounting for the interval between commercial and study vaccine dose. Injection-site and systemic adverse events (AEs) will be collected for 15 days and serious AEs for 12 months post-vaccination; vaccine-related serious AEs and deaths will be collected throughout the study. Results will inform completion of vaccination in individuals who did not complete the recommended series and guide implementation of vaccination programs in resource-limited settings.
Collapse
Affiliation(s)
- Hedy Teppler
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Oliver Bautista
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | -
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Sheryl Flores
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Jennifer McCauley
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Alain Luxembourg
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA.
| |
Collapse
|
6
|
Aldakak L, Huber VM, Rühli F, Bender N. Sex difference in the immunogenicity of the quadrivalent Human Papilloma Virus vaccine: Systematic review and meta-analysis. Vaccine 2021; 39:1680-1686. [PMID: 33637386 DOI: 10.1016/j.vaccine.2021.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Immunological differences between males and females in response to viral vaccines are well known. This the first review to examine them for the Human Papilloma Virus. METHODS We conducted a systematic review and meta-analysis of the immunogenicity of the Quadrivalent Human Papilloma Virus Vaccine qHPVV. We searched Medline, Embase, and CENTRAL for trials published until September 17, 2019. Inclusion criteria were 3-doses and reporting geometric mean titers (GMTs). We performed random-effects meta-analyses and meta-regression separated by age group and sex. RESULTS Our search yielded 1809 unique studies. 334 full texts were screened and data from 18 studies were extracted. Females had higher pooled geometric mean titers than males in all age groups. Log transformed GMTs in male children (<16) years were: against HPV6: 6·62 (95% CI 6·29-6·94; I2 = 86·0%), against HPV11: 7·07 (95% CI 6·90-7·23; I2 = 63.1%), against HPV16: 8·53 (95% CI 8·28-8·78; I2 = 73·0%), and against HPV18 7·21 (95% CI 7·08-7·34; I2 = 26·4%). In females: against HPV6 7·10 (95% CI 6·79-7·41; I2 = 96·6%), HPV11: 7·32 (95% CI 7·15-7·50; I2 = 90·6%), HPV16: 8·71 (95% CI 8·52-8·91; I2 = 90·2%), and HPV18 7·35 (95% CI 7·11-7·58; I2 = 92·7%). In the meta-regression, the sexual difference was significant for HPV6 (p = 0·022) with a similar tendency for HPV11 (p = 0·066) and HPV18 (p = 0·079). Immunogenicity was significantly higher in children (<16) than in adults (p < 0·001). CONCLUSION Females have higher antibody titers against HPV after receiving the qHPVV than do males. The difference is bigger in low-risk HPV strains. Adjusting the doses and schedules for each sex should be explored further.
Collapse
Affiliation(s)
- Lafi Aldakak
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland.
| | - Vera Maria Huber
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Frank Rühli
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Nicole Bender
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| |
Collapse
|
7
|
Bornstein J, Roux S, Kjeld Petersen L, Huang LM, Dobson SR, Pitisuttithum P, Diez-Domingo J, Schilling A, Ariffin H, Tytus R, Rupp R, Senders S, Engel E, Ferris D, Kim YJ, Tae Kim Y, Kurugol Z, Bautista O, Nolan KM, Sankaranarayanan S, Saah A, Luxembourg A. Three-Year Follow-up of 2-Dose Versus 3-Dose HPV Vaccine. Pediatrics 2021; 147:peds.2019-4035. [PMID: 33386332 DOI: 10.1542/peds.2019-4035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Human papillomavirus (HPV) antibody responses to the 9-valent human papillomavirus (9vHPV) vaccine among girls and boys (aged 9-14 years) receiving 2-dose regimens (months 0, 6 or 0, 12) were noninferior to a 3-dose regimen (months 0, 2, 6) in young women (aged 16-26 years) 4 weeks after last vaccination in an international, randomized, open-label trial (NCT01984697). We assessed response durability through month 36. METHODS Girls received 2 (months 0 and 6 [0, 6]: n = 301; months 0 and 12 [0, 12]: n = 151) or 3 doses (months 0,2, and 6 [0, 2, 6]: n = 301); boys received 2 doses ([0, 6]: n = 301; [0, 12]: n = 150); and young women received 3 doses ([0, 2, 6]: n = 314) of 9vHPV vaccine. Anti-HPV geometric mean titers (GMTs) were assessed by competitive Luminex immunoassay (cLIA) and immunoglobulin G-Luminex immunoassay (IgG-LIA) through month 36. RESULTS Anti-HPV GMTs were highest 1 month after the last 9vHPV vaccine regimen dose, decreased sharply during the subsequent 12 months, and then decreased more slowly. GMTs 2 to 2.5 years after the last regimen dose in girls and boys given 2 doses were generally similar to or greater than GMTs in young women given 3 doses. Across HPV types, most boys and girls who received 2 doses (cLIA: 81%-100%; IgG-LIA: 91%-100%) and young women who received 3 doses (cLIA: 78%-98%; IgG-LIA: 91%-100%) remained seropositive 2 to 2.5 years after the last regimen dose. CONCLUSIONS Antibody responses persisted through 2 to 2.5 years after the last dose of a 2-dose 9vHPV vaccine regimen in girls and boys. In girls and boys, antibody responses generated by 2 doses administered 6 to 12 months apart may be sufficient to induce high-level protective efficacy through at least 2 years after the second dose.
Collapse
Affiliation(s)
- Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Surita Roux
- Synexus Clinical Research SA, Somerset West, Cape Town, South Africa
| | - Lone Kjeld Petersen
- Open Patient Data Explorative Network and Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei City, Taiwan
| | - Simon R Dobson
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand
| | - Javier Diez-Domingo
- Vaccine Research Department, Foundation for the Promotion of Health and Biomedical Research of Valencia Region - Public Health, Valencia, Spain
| | - Andrea Schilling
- Department of Obstetrics and Gynecology, Facultad de Medicina Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Hany Ariffin
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Richard Tytus
- Hamilton Medical Research Group, Hamilton, Ontario, Canada
| | - Richard Rupp
- The University of Texas Medical Branch, Galveston, Texas
| | | | - Eli Engel
- Bayview Research Group, Valley Village, California
| | - Daron Ferris
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Zafer Kurugol
- Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey; and
| | | | | | | | | | | |
Collapse
|
8
|
Secor AM, Driver M, Kharono B, Hergott D, Liu G, Barnabas RV, Dull P, Hawes SE, Drain PK. Immunogenicity of Alternative Dosing Schedules for HPV Vaccines among Adolescent Girls and Young Women: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2020; 8:vaccines8040618. [PMID: 33092049 PMCID: PMC7712330 DOI: 10.3390/vaccines8040618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/23/2022] Open
Abstract
Alternative dosing schedules for licensed human papilloma virus (HPV) vaccines, particularly single dose and extended intervals between doses (>12 months), are being considered to address vaccine shortages and improve operational flexibility. We searched PUBMED/MEDLINE for publications reporting immunogenicity data following administration of one of the licensed HPV vaccines (2vHPV, 4vHPV, and 9vHPV) to females aged 9–26 years. We conducted non-inferiority analyses comparing alternative to standard schedules using mixed effects meta-regression controlling for baseline HPV status and disaggregated by vaccine, subtype, time point, and age group (9–14 and 15–26 years). Non-inferiority was defined as the lower bound of the 95% confidence interval (CI) for the geometric mean titer (GMT) ratio being greater than 0.5. Our search returned 2464 studies, of which 23 were included in data analyses. When evaluated against standard schedules, although robust immunogenicity was demonstrated across all multi-dose groups, non-inferiority of extended interval dosing was mixed across vaccines, subtypes, and time points. Single dose did not meet the criteria for non-inferiority in any comparisons. Sparse data limited the number of possible comparisons, and further research is warranted.
Collapse
Affiliation(s)
- Andrew M. Secor
- START Center, University of Washington, Seattle, WA 98195, USA; (M.D.); (B.K.); (D.H.); (S.E.H.); (P.K.D.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
- Correspondence: ; Tel.: +1-(603)-491-9465
| | - Matthew Driver
- START Center, University of Washington, Seattle, WA 98195, USA; (M.D.); (B.K.); (D.H.); (S.E.H.); (P.K.D.)
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Brenda Kharono
- START Center, University of Washington, Seattle, WA 98195, USA; (M.D.); (B.K.); (D.H.); (S.E.H.); (P.K.D.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
| | - Dianna Hergott
- START Center, University of Washington, Seattle, WA 98195, USA; (M.D.); (B.K.); (D.H.); (S.E.H.); (P.K.D.)
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Gui Liu
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Ruanne V. Barnabas
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Peter Dull
- Bill and Melinda Gates Foundation, Seattle, WA 98109, USA;
| | - Stephen E. Hawes
- START Center, University of Washington, Seattle, WA 98195, USA; (M.D.); (B.K.); (D.H.); (S.E.H.); (P.K.D.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA;
| | - Paul K. Drain
- START Center, University of Washington, Seattle, WA 98195, USA; (M.D.); (B.K.); (D.H.); (S.E.H.); (P.K.D.)
- Department of Global Health, University of Washington, Seattle, WA 98195, USA;
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
9
|
Bruce MG, Meites E, Bulkow L, Panicker G, Hurlburt D, Lecy D, Thompson G, Rudolph K, Unger ER, Hennessy T, Markowitz LE. A prospective cohort study of immunogenicity of quadrivalent human papillomavirus vaccination among Alaska Native Children, Alaska, United States. Vaccine 2020; 38:6585-6591. [PMID: 32814639 DOI: 10.1016/j.vaccine.2020.08.005] [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: 04/27/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In the United States, HPV vaccination is routinely recommended at age 11 or 12 years; the series can be started at age 9. We conducted a cohort study to assess long-term immunogenicity of quadrivalent HPV vaccine (4vHPV) in an American Indian/Alaska Native (AI/AN) Indigenous population. METHODS During 2011-2014, we enrolled AI/AN girls and boys aged 9-14 years, who were vaccinated with a 3-dose series of 4vHPV. Serum specimens were collected at five time points: immediately prior to doses 2 and 3, and at one month, one year, and two years after series completion. Antibody testing was performed using a multiplex virus-like-particle-IgG ELISA for 4vHPV types (HPV 6/11/16/18). RESULTS Among 477 children (405 girls/72 boys) completing the 3-dose series, median age at enrollment was 11.2 years. Of the 477, 72 (15%) were tested before dose 2 and 70 (15%) before dose 3. Following series completion, 435 (91%) were tested at one month, 382 (80%) at one year, and 351 (74%) at two years. All tested participants had detectable antibody to 4vHPV types at all time points measured. Geometric mean concentrations (GMCs) for 4vHPV types at one month and two years post-series completion were 269.9 and 32.7 AU/ml for HPV6, 349.3 and 42.9 AU/ml for HPV11, 1240.2 and 168.3 IU/ml HPV16, and 493.2 and 52.2 IU/ml for HPV18. Among children tested after each dose, GMCs after doses 1 and 2 were 3.9 and 32.2 AU/ml for HPV6, 5.3 and 45.6 AU/ml for HPV11, 20.8 and 187.9 IU/ml for HPV16; and 6.6 and 49.7 IU/ml for HPV18. No serious adverse events were reported. CONCLUSION All AI/AN children developed antibodies to all 4vHPV types after vaccination. GMCs rose after each dose, then decreased to a plateau over the subsequent two years. This cohort will continue to be followed to determine duration of antibody response.
Collapse
Affiliation(s)
- Michael G Bruce
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA.
| | - Elissa Meites
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa Bulkow
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Debby Hurlburt
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Danielle Lecy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Gail Thompson
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - 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
| | - Thomas Hennessy
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Lauri E Markowitz
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
10
|
Yu XJ, Li J, Lin ZJ, Zhao H, Lin BZ, Qiao YL, Hu YM, Wei LH, Li RC, Huang WD, Wu T, Huang SJ, Li CG, Pan HR, Zhang J. Immunogenicity of an Escherichia coli-produced bivalent human papillomavirus vaccine under different vaccination intervals. Hum Vaccin Immunother 2020; 16:1630-1635. [PMID: 32544361 DOI: 10.1080/21645515.2020.1761202] [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: 10/24/2022] Open
Abstract
A new Escherichia coli-produced human papillomavirus (HPV)-16/18 vaccine has been shown to be safe and highly efficacious and was recently licensed in China. As a post hoc analysis of the phase III trial, this study aimed to assess the impact of vaccination time deviations on the specific antibody response and guide the better usage of this vaccine in the real world. A total of 3689 healthy women aged 18-45 years old were randomly assigned to receive the bivalent HPV-16/18 vaccine according to a 0-, 1- and 6-month schedule with a wide vaccination interval. The first vaccination interval between the 1st and 2nd doses (the 1st interval) was divided into three groups: 28-40 d, 41-50 d and 51-60 d. The second vaccination interval between the 2nd and 3rd doses (the 2nd interval) was divided into three groups: 103-139 d, 140-160 d and 161-198 d. The reverse cumulative curves for the IgG of the three groups with different 1st vaccination intervals or with different 2nd vaccination intervals at month 7 almost overlapped for both HPV-16 and HPV-18. Compared with the standard vaccination schedule (a 1st interval of 28-40 d and a 2nd interval of 140-160 d) subgroup, all the subgroups had GMC ratios greater than 0.83, with the lower limit of 95% CIs higher than 0.64. In conclusion, a slight deviation in the vaccination time of the 2nd and 3rd doses has only a minor, insignificant impact on the immune response induced by the Escherichia coli-produced HPV-16/18 vaccine.
Collapse
Affiliation(s)
- Xiao-Juan Yu
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics(SCIBP), School of Public Health, Xiamen University , Xiamen, Fujian, China
| | - Juan Li
- Division of Respiratory Virus Vaccines, National Institute for Food and Drug Control , Beijing, China
| | - Zhi-Jie Lin
- Vaccine R&D Department, Xiamen Innovax Biotech Company , Xiamen, Fujian, China
| | - Hui Zhao
- Division of Respiratory Virus Vaccines, National Institute for Food and Drug Control , Beijing, China
| | - Bi-Zhen Lin
- Vaccine R&D Department, Xiamen Innovax Biotech Company , Xiamen, Fujian, China
| | - You-Lin Qiao
- Department of Cancer Epidemiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing, China
| | - Yue-Mei Hu
- Department of Vaccine Evaluation, Jiangsu Provincial Center for Disease Control and Prevention , Nanjing, Jiangsu, China
| | - Li-Hui Wei
- Department of Obstetrics and Gynecology, Peking University People's Hospital , Beijing, China
| | - Rong-Cheng Li
- Center for Vaccine Clinical Research, Guangxi Center for Disease Control and Prevention , Nanning, Guangxi, China
| | - Wei-Dan Huang
- Vaccine R&D Department, Xiamen Innovax Biotech Company , Xiamen, Fujian, China
| | - Ting Wu
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics(SCIBP), School of Public Health, Xiamen University , Xiamen, Fujian, China
| | - Shou-Jie Huang
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics(SCIBP), School of Public Health, Xiamen University , Xiamen, Fujian, China
| | - Chang-Gui Li
- Division of Respiratory Virus Vaccines, National Institute for Food and Drug Control , Beijing, China
| | - Hui-Rong Pan
- Vaccine R&D Department, Xiamen Innovax Biotech Company , Xiamen, Fujian, China
| | - Jun Zhang
- The State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics(SCIBP), School of Public Health, Xiamen University , Xiamen, Fujian, China
| |
Collapse
|
11
|
Nicholls SG, Zwarenstein M, Hey SP, Giraudeau B, Campbell MK, Taljaard M. The importance of decision intent within descriptions of pragmatic trials. J Clin Epidemiol 2020; 125:30-37. [PMID: 32422248 DOI: 10.1016/j.jclinepi.2020.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/02/2020] [Accepted: 04/16/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE It is now more than 50 years since the concepts of explanatory and pragmatic attitudes toward trials were first discussed by Schwartz and Lellouch in their influential 1967 paper. Since then, there has been increasing focus on design aspects that may be consistent with more pragmatic attitudes within clinical trials, and a number of tools developed to assist investigators prospectively think about their trial design. Researchers have subsequently expressed interest in using these tools retrospectively to characterize trials as pragmatic or explanatory. RESULTS We suggest that recent attempts to retrospectively dichotomize trials solely on the basis of quantitative scoring of trial design features are flawed. Instead, we argue that there is a need to consider both the intent and design when assessing the degree of pragmatism within a trial. CONCLUSION The practical implication of our suggestion for trial reporting is that investigators should explicitly state the intent of the trial through a clear articulation of the decision that they hope will be informed by the trial results. This should be coupled with a completed PRagmatic-Explanatory Continuum Indicator Summary 2 assessment (or similar) with an explanation of study design choices to appropriately assess whether the study design is consistent with the study intent. We believe this will assist reviewers and knowledge users in making assessments of trials.
Collapse
Affiliation(s)
- Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada.
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France; INSERM CIC1415, CHRU de Tours, Tours, France
| | | | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| |
Collapse
|
12
|
Bergman H, Buckley BS, Villanueva G, Petkovic J, Garritty C, Lutje V, Riveros‐Balta AX, Low N, Henschke N. Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males. Cochrane Database Syst Rev 2019; 2019:CD013479. [PMID: 31755549 PMCID: PMC6873216 DOI: 10.1002/14651858.cd013479] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccine remains low in many countries, although the bivalent and quadrivalent HPV vaccines given as a three-dose schedule are effective in the prevention of precancerous lesions of the cervix in women. Simpler immunisation schedules, such as those with fewer doses, might reduce barriers to vaccination, as may programmes that include males. OBJECTIVES To evaluate the efficacy, immunogenicity, and harms of different dose schedules and different types of HPV vaccines in females and males. SEARCH METHODS We conducted electronic searches on 27 September 2018 in Ovid MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library), and Ovid Embase. We also searched the WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov (both 27 September 2018), vaccine manufacturer websites, and checked reference lists from an index of HPV studies and other relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) with no language restriction. We considered studies if they enrolled HIV-negative males or females aged 9 to 26 years, or HIV-positive males or females of any age. DATA COLLECTION AND ANALYSIS We used methods recommended by Cochrane. We use the term 'control' to refer to comparator products containing an adjuvant or active vaccine and 'placebo' to refer to products that contain no adjuvant or active vaccine. Most primary outcomes in this review were clinical outcomes. However, for comparisons comparing dose schedules, the included RCTs were designed to measure antibody responses (i.e. immunogenicity) as the primary outcome, rather than clinical outcomes, since it is unethical to collect cervical samples from girls under 16 years of age. We analysed immunogenicity outcomes (i.e. geometric mean titres) with ratios of means, clinical outcomes (e.g. cancer and intraepithelial neoplasia) with risk ratios or rate ratios and, for serious adverse events and deaths, we calculated odds ratios. We rated the certainty of evidence with GRADE. MAIN RESULTS We included 20 RCTs with 31,940 participants. The length of follow-up in the included studies ranged from seven months to five years. Two doses versus three doses of HPV vaccine in 9- to 15-year-old females Antibody responses after two-dose and three-dose HPV vaccine schedules were similar after up to five years of follow-up (4 RCTs, moderate- to high-certainty evidence). No RCTs collected clinical outcome data. Evidence about serious adverse events in studies comparing dose schedules was of very low-certainty owing to imprecision and indirectness (three doses 35/1159; two doses 36/1158; 4 RCTs). One death was reported in the three-dose group (1/898) and none in the two-dose group (0/899) (low-certainty evidence). Interval between doses of HPV vaccine in 9- to 14-year-old females and males Antibody responses were stronger with a longer interval (6 or 12 months) between the first two doses of HPV vaccine than a shorter interval (2 or 6 months) at up to three years of follow-up (4 RCTs, moderate- to high-certainty evidence). No RCTs collected data about clinical outcomes. Evidence about serious adverse events in studies comparing intervals was of very low-certainty, owing to imprecision and indirectness. No deaths were reported in any of the studies (0/1898, 3 RCTs, low-certainty evidence). HPV vaccination of 10- to 26-year-old males In one RCT there was moderate-certainty evidence that quadrivalent HPV vaccine, compared with control, reduced the incidence of external genital lesions (control 36 per 3081 person-years; quadrivalent 6 per 3173 person-years; rate ratio 0.16, 95% CI 0.07 to 0.38; 6254 person-years) and anogenital warts (control 28 per 2814 person-years; quadrivalent 3 per 2831 person-years; rate ratio 0.11, 95% CI 0.03 to 0.38; 5645 person-years). The quadrivalent vaccine resulted in more injection-site adverse events, such as pain or redness, than control (537 versus 601 per 1000; risk ratio (RR) 1.12, 95% CI 1.06 to 1.18, 3895 participants, high-certainty evidence). There was very low-certainty evidence from two RCTs about serious adverse events with quadrivalent vaccine (control 12/2588; quadrivalent 8/2574), and about deaths (control 11/2591; quadrivalent 3/2582), owing to imprecision and indirectness. Nonavalent versus quadrivalent vaccine in 9- to 26-year-old females and males Three RCTs were included; one in females aged 9- to 15-years (n = 600), one in females aged 16- to 26-years (n = 14,215), and one in males aged 16- to 26-years (n = 500). The RCT in 16- to 26-year-old females reported clinical outcomes. There was little to no difference in the incidence of the combined outcome of high-grade cervical epithelial neoplasia, adenocarcinoma in situ, or cervical cancer between the HPV vaccines (quadrivalent 325/6882, nonavalent 326/6871; OR 1.00, 95% CI 0.85 to 1.16; 13,753 participants; high-certainty evidence). The other two RCTs did not collect data about clinical outcomes. There were slightly more local adverse events with the nonavalent vaccine (905 per 1000) than the quadrivalent vaccine (846 per 1000) (RR 1.07, 95% CI 1.05 to 1.08; 3 RCTs, 15,863 participants; high-certainty evidence). Comparative evidence about serious adverse events in the three RCTs (nonavalent 243/8234, quadrivalent 192/7629; OR 0.60, 95% CI 0.14 to 2.61) was of low certainty, owing to imprecision and indirectness. HPV vaccination for people living with HIV Seven RCTs reported on HPV vaccines in people with HIV, with two small trials that collected data about clinical outcomes. Antibody responses were higher following vaccination with either bivalent or quadrivalent HPV vaccine than with control, and these responses could be demonstrated to have been maintained for up to 24 months in children living with HIV (low-certainty evidence). The evidence about clinical outcomes and harms for HPV vaccines in people with HIV is very uncertain (low- to very low-certainty evidence), owing to imprecision and indirectness. AUTHORS' CONCLUSIONS The immunogenicity of two-dose and three-dose HPV vaccine schedules, measured using antibody responses in young females, is comparable. The quadrivalent vaccine probably reduces external genital lesions and anogenital warts in males compared with control. The nonavalent and quadrivalent vaccines offer similar protection against a combined outcome of cervical, vaginal, and vulval precancer lesions or cancer. In people living with HIV, both the bivalent and quadrivalent HPV vaccines result in high antibody responses. For all comparisons of alternative HPV vaccine schedules, the certainty of the body of evidence about serious adverse events reported during the study periods was low or very low, either because the number of events was low, or the evidence was indirect, or both. Post-marketing surveillance is needed to continue monitoring harms that might be associated with HPV vaccines in the population, and this evidence will be incorporated in future updates of this review. Long-term observational studies are needed to determine the effectiveness of reduced-dose schedules against HPV-related cancer endpoints, and whether adopting these schedules improves vaccine coverage rates.
Collapse
Affiliation(s)
- Hanna Bergman
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Brian S Buckley
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
- University of PhillipinesDepartment of SurgeryManilaPhilippines
| | - Gemma Villanueva
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Jennifer Petkovic
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
- University of OttawaBruyère Research Institute43 Bruyère StAnnex E, room 312OttawaONCanadaK1N 5C8
| | - Chantelle Garritty
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
- Ottawa Hospital Research InstituteOttawa Methods Centre, Clinical Epidemiology ProgramOttawaOntarioCanadaK1H 8L1
| | - Vittoria Lutje
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolUKL3 5QA
| | | | - Nicola Low
- University of BernInstitute of Social and Preventive Medicine (ISPM)Finkenhubelweg 11BernSwitzerlandCH‐3012
| | - Nicholas Henschke
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | | |
Collapse
|
13
|
Castle PE, Pierz A. (At Least) Once in Her Lifetime: Global Cervical Cancer Prevention. Obstet Gynecol Clin North Am 2019; 46:107-123. [DOI: 10.1016/j.ogc.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
14
|
Lazcano-Ponce E, Salmerón J, González A, Allen-Leigh B, León-Maldonado L, Magis C, Aranda-Flores C, Conde-González C, Portillo-Romero AJ, Yunes-Díaz E, Rivera-Rivera L, Vargas G, Nyitray AG, Giuliano AR. Prevention and control of neoplasms associated with HPV in high-risk groups in Mexico City: The Condesa Study. ACTA ACUST UNITED AC 2018. [DOI: 10.21149/10034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
15
|
Gilca V, Salmerón-Castro J, Sauvageau C, Ogilvie G, Landry M, Naus M, Lazcano-Ponce E. Early use of the HPV 2-dose vaccination schedule: Leveraging evidence to support policy for accelerated impact. Vaccine 2018; 36:4800-4805. [PMID: 29887322 PMCID: PMC6078939 DOI: 10.1016/j.vaccine.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/16/2018] [Accepted: 02/01/2018] [Indexed: 02/07/2023]
Abstract
Although human papillomavirus (HPV) vaccines were initially licensed based on efficacy after three-dose regimens in women aged 15-26 years, it was recognized early in clinical development that comparable immunogenicity could be obtained after just two doses when administered to younger girls. In both Canada and Mexico, public health authorities made the decision to administer two doses 6 months apart with a planned additional dose at 60 months, while simultaneously doing further study to determine if the third dose would confer meaningful additional benefit. This delayed third dose approach permitted a more cost-effective program with opportunities for improved compliance while minimizing injections and leaving open the opportunity to provide a full three-dose vaccination series. It required close cooperation across many governmental and civil society leadership bodies and real-time access to emerging data on HPV vaccine effectiveness. Although still limited, there is increasing evidence that even one-dose vaccination is sufficient to provide prolonged protection against HPV infection and associated diseases. Ongoing clinical trials and ecological studies are expected to consolidate existing data regarding one dose schedule use. However, to accelerate the preventive effect of HPV vaccination some jurisdictions, in particular those with limited resources may already consider the initiation of a one dose vaccination with the possibility of giving the second dose later in life if judged necessary. Such an approach would facilitate vaccination implementation and might permit larger catch-up vaccination programs in older girls (or as appropriate, girls and boys), thereby accelerating the impact on cervical cancer and other HPV-associated diseases.
Collapse
Affiliation(s)
- Vladimir Gilca
- Quebec Public Health Institute, Quebec, Canada; Laval University Research Hospital Center, Quebec, Canada.
| | - Jorge Salmerón-Castro
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico; Unidad Académica en Investigación Epidemiológica, Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - Chantal Sauvageau
- Quebec Public Health Institute, Quebec, Canada; Laval University Research Hospital Center, Quebec, Canada
| | - Gina Ogilvie
- University of British Columbia, Vancouver, Canada; BC Women's Hospital and Health Centre, Vancouver, Canada
| | - Monique Landry
- Quebec Ministry of Health and Social Services, Montreal, Canada
| | - Monica Naus
- University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, Canada
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| |
Collapse
|
16
|
Arbyn M, Xu L, Simoens C, Martin‐Hirsch PPL. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev 2018; 5:CD009069. [PMID: 29740819 PMCID: PMC6494566 DOI: 10.1002/14651858.cd009069.pub3] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Persistent infection with high-risk human papillomaviruses (hrHPV) types is causally linked with the development of cervical precancer and cancer. HPV types 16 and 18 cause approximately 70% of cervical cancers worldwide. OBJECTIVES To evaluate the harms and protection of prophylactic human papillomaviruses (HPV) vaccines against cervical precancer and HPV16/18 infection in adolescent girls and women. SEARCH METHODS We searched MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase (June 2017) for reports on effects from trials. We searched trial registries and company results' registers to identify unpublished data for mortality and serious adverse events. SELECTION CRITERIA Randomised controlled trials comparing efficacy and safety in females offered HPV vaccines with placebo (vaccine adjuvants or another control vaccine). DATA COLLECTION AND ANALYSIS We used Cochrane methodology and GRADE to rate the certainty of evidence for protection against cervical precancer (cervical intraepithelial neoplasia grade 2 and above [CIN2+], CIN grade 3 and above [CIN3+], and adenocarcinoma-in-situ [AIS]), and for harms. We distinguished between the effects of vaccines by participants' baseline HPV DNA status. The outcomes were precancer associated with vaccine HPV types and precancer irrespective of HPV type. Results are presented as risks in control and vaccination groups and risk ratios (RR) with 95% confidence intervals in brackets. MAIN RESULTS We included 26 trials (73,428 participants). Ten trials, with follow-up of 1.3 to 8 years, addressed protection against CIN/AIS. Vaccine safety was evaluated over a period of 6 months to 7 years in 23 studies. Studies were not large enough or of sufficient duration to evaluate cervical cancer outcomes. All but one of the trials was funded by the vaccine manufacturers. We judged most included trials to be at low risk of bias. Studies involved monovalent (N = 1), bivalent (N = 18), and quadrivalent vaccines (N = 7). Most women were under 26 years of age. Three trials recruited women aged 25 and over. We summarize the effects of vaccines in participants who had at least one immunisation.Efficacy endpoints by initial HPV DNA statushrHPV negativeHPV vaccines reduce CIN2+, CIN3+, AIS associated with HPV16/18 compared with placebo in adolescent girls and women aged 15 to 26. There is high-certainty evidence that vaccines lower CIN2+ from 164 to 2/10,000 (RR 0.01 (0 to 0.05)) and CIN3+ from 70 to 0/10,000 (RR 0.01 (0.00 to 0.10). There is moderate-certainty evidence that vaccines reduce the risk of AIS from 9 to 0/10,000 (RR 0.10 (0.01 to 0.82).HPV vaccines reduce the risk of any CIN2+ from 287 to 106/10,000 (RR 0.37 (0.25 to 0.55), high certainty) and probably reduce any AIS lesions from 10 to 0/10,000 (RR 0.1 (0.01 to 0.76), moderate certainty). The size of reduction in CIN3+ with vaccines differed between bivalent and quadrivalent vaccines (bivalent: RR 0.08 (0.03 to 0.23), high certainty; quadrivalent: RR 0.54 (0.36 to 0.82), moderate certainty). Data in older women were not available for this comparison.HPV16/18 negativeIn those aged 15 to 26 years, vaccines reduce CIN2+ associated with HPV16/18 from 113 to 6 /10,000 (RR 0.05 (0.03 to 0.10). In women 24 years or older the absolute and relative reduction in the risk of these lesions is smaller (from 45 to 14/10,000, (RR 0.30 (0.11 to 0.81), moderate certainty). HPV vaccines reduce the risk of CIN3+ and AIS associated with HPV16/18 in younger women (RR 0.05 (0.02 to 0.14), high certainty and RR 0.09 (0.01 to 0.72), moderate certainty, respectively). No trials in older women have measured these outcomes.Vaccines reduce any CIN2+ from 231 to 95/10,000, (RR 0.41 (0.32 to 0.52)) in younger women. No data are reported for more severe lesions.Regardless of HPV DNA statusIn younger women HPV vaccines reduce the risk of CIN2+ associated with HPV16/18 from 341 to 157/10,000 (RR 0.46 (0.37 to 0.57), high certainty). Similar reductions in risk were observed for CIN3+ associated with HPV16/18 (high certainty). The number of women with AIS associated with HPV16/18 is reduced from 14 to 5/10,000 with HPV vaccines (high certainty).HPV vaccines reduce any CIN2+ from 559 to 391/10,000 (RR 0.70 (0.58 to 0.85, high certainty) and any AIS from 17 to 5/10,000 (RR 0.32 (0.15 to 0.67), high certainty). The reduction in any CIN3+ differed by vaccine type (bivalent vaccine: RR 0.55 (0.43 to 0.71) and quadrivalent vaccine: RR 0.81 (0.69 to 0.96)).In women vaccinated at 24 to 45 years of age, there is moderate-certainty evidence that the risks of CIN2+ associated with HPV16/18 and any CIN2+ are similar between vaccinated and unvaccinated women (RR 0.74 (0.52 to 1.05) and RR 1.04 (0.83 to 1.30) respectively). No data are reported in this age group for CIN3+ or AIS.Adverse effectsThe risk of serious adverse events is similar between control and HPV vaccines in women of all ages (669 versus 656/10,000, RR 0.98 (0.92 to 1.05), high certainty). Mortality was 11/10,000 in control groups compared with 14/10,000 (9 to 22) with HPV vaccine (RR 1.29 [0.85 to 1.98]; low certainty). The number of deaths was low overall but there is a higher number of deaths in older women. No pattern in the cause or timing of death has been established.Pregnancy outcomesAmong those who became pregnant during the studies, we did not find an increased risk of miscarriage (1618 versus 1424/10,000, RR 0.88 (0.68 to 1.14), high certainty) or termination (931 versus 838/10,000 RR 0.90 (0.80 to 1.02), high certainty). The effects on congenital abnormalities and stillbirths are uncertain (RR 1.22 (0.88 to 1.69), moderate certainty and (RR 1.12 (0.68 to 1.83), moderate certainty, respectively). AUTHORS' CONCLUSIONS There is high-certainty evidence that HPV vaccines protect against cervical precancer in adolescent girls and young women aged 15 to 26. The effect is higher for lesions associated with HPV16/18 than for lesions irrespective of HPV type. The effect is greater in those who are negative for hrHPV or HPV16/18 DNA at enrolment than those unselected for HPV DNA status. There is moderate-certainty evidence that HPV vaccines reduce CIN2+ in older women who are HPV16/18 negative, but not when they are unselected by HPV DNA status.We did not find an increased risk of serious adverse effects. Although the number of deaths is low overall, there were more deaths among women older than 25 years who received the vaccine. The deaths reported in the studies have been judged not to be related to the vaccine. Increased risk of adverse pregnancy outcomes after HPV vaccination cannot be excluded, although the risk of miscarriage and termination are similar between trial arms. Long-term of follow-up is needed to monitor the impact on cervical cancer, occurrence of rare harms and pregnancy outcomes.
Collapse
Affiliation(s)
- Marc Arbyn
- SciensanoUnit of Cancer Epidemiology, Belgian Cancer CentreJuliette Wytsmanstreet 14BrusselsBelgiumB‐1050
| | - Lan Xu
- SciensanoUnit of Cancer Epidemiology, Belgian Cancer CentreJuliette Wytsmanstreet 14BrusselsBelgiumB‐1050
| | - Cindy Simoens
- University of AntwerpLaboratory of Cell Biology and HistologyGroenenborgerlaan 171AntwerpBelgiumB‐2020
| | - Pierre PL Martin‐Hirsch
- Royal Preston Hospital, Lancashire Teaching Hospital NHS TrustGynaecological Oncology UnitSharoe Green LaneFullwoodPrestonLancashireUKPR2 9HT
| | | |
Collapse
|
17
|
Agbla SC, DiazOrdaz K. Reporting non-adherence in cluster randomised trials: A systematic review. Clin Trials 2018; 15:294-304. [PMID: 29608096 DOI: 10.1177/1740774518761666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Treatment non-adherence in randomised trials refers to situations where some participants do not receive their allocated treatment as intended. For cluster randomised trials, where the unit of randomisation is a group of participants, non-adherence may occur at the cluster or individual level. When non-adherence occurs, randomisation no longer guarantees that the relationship between treatment receipt and outcome is unconfounded, and the power to detect the treatment effects in intention-to-treat analysis may be reduced. Thus, recording adherence and estimating the causal treatment effect adequately are of interest for clinical trials. OBJECTIVES To assess the extent of reporting of non-adherence issues in published cluster trials and to establish which methods are currently being used for addressing non-adherence, if any, and whether clustering is accounted for in these. METHODS We systematically reviewed 132 cluster trials published in English in 2011 previously identified through a search in PubMed. RESULTS One-hundred and twenty three cluster trials were included in this systematic review. Non-adherence was reported in 56 cluster trials. Among these, 19 reported a treatment efficacy estimate: per protocol in 15 and as treated in 4. No study discussed the assumptions made by these methods, their plausibility or the sensitivity of the results to deviations from these assumptions. LIMITATIONS The year of publication of the cluster trials included in this review (2011) could be considered a limitation of this study; however, no new guidelines regarding the reporting and the handling of non-adherence for cluster trials have been published since. In addition, a single reviewer undertook the data extraction. To mitigate this, a second reviewer conducted a validation of the extraction process on 15 randomly selected reports. Agreement was satisfactory (93%). CONCLUSION Despite the recommendations of the Consolidated Standards of Reporting Trials statement extension to cluster randomised trials, treatment adherence is under-reported. Among the trials providing adherence information, there was substantial variation in how adherence was defined, handled and reported. Researchers should discuss the assumptions required for the results to be interpreted causally and whether these are scientifically plausible in their studies. Sensitivity analyses to study the robustness of the results to departures from these assumptions should be performed.
Collapse
Affiliation(s)
- Schadrac C Agbla
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Karla DiazOrdaz
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| |
Collapse
|
18
|
Pinto LA, Dillner J, Beddows S, Unger ER. Immunogenicity of HPV prophylactic vaccines: Serology assays and their use in HPV vaccine evaluation and development. Vaccine 2018; 36:4792-4799. [PMID: 29361344 PMCID: PMC6050153 DOI: 10.1016/j.vaccine.2017.11.089] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/17/2017] [Indexed: 11/23/2022]
Abstract
When administered as standard three-dose schedules, the licensed HPV prophylactic vaccines have demonstrated extraordinary immunogenicity and efficacy. We summarize the immunogenicity of these licensed vaccines and the most commonly used serology assays, with a focus on key considerations for one-dose vaccine schedules. Although immune correlates of protection against infection are not entirely clear, both preclinical and clinical evidence point to neutralizing antibodies as the principal mechanism of protection. Thus, immunogenicity assessments in vaccine trials have focused on measurements of antibody responses to the vaccine. Non-inferiority of antibody responses after two doses of HPV vaccines separated by 6 months has been demonstrated and this evidence supported the recent WHO recommendations for two-dose vaccination schedules in both boys and girls 9–14 years of age. There is also some evidence suggesting that one dose of HPV vaccines may provide protection similar to the currently recommended two-dose regimens but robust data on efficacy and immunogenicity of one-dose vaccine schedules are lacking. In addition, immunogenicity has been assessed and reported using different methods, precluding direct comparison of results between different studies and vaccines. New head-to-head vaccine trials evaluating one-dose immunogenicity and efficacy have been initiated and an increase in the number of trials relying on immunobridging is anticipated. Therefore, standardized measurement and reporting of immunogenicity for the up to nine HPV types targeted by the current vaccines is now critical. Building on previous HPV serology assay standardization and harmonization efforts initiated by the WHO HPV LabNet in 2006, new secondary standards, critical reference reagents and testing guidelines will be generated as part of a new partnership to facilitate harmonization of the immunogenicity testing in new HPV vaccine trials.
Collapse
Affiliation(s)
- Ligia A Pinto
- Vaccine, Cancer and Immunity Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, MD, USA.
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, 141 86 Stockholm, Sweden.
| | - Simon Beddows
- Virus Reference Department, Public Health England, London, UK.
| | - Elizabeth R Unger
- Chronic Viral Diseases Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
19
|
Widdice LE, Unger ER, Panicker G, Hoagland R, Callahan ST, Jackson LA, Berry AA, Kotloff K, Frey SE, Harrison CJ, Pahud BA, Edwards KM, Mulligan MJ, Sudman J, Bernstein DI. Antibody responses among adolescent females receiving two or three quadrivalent human papillomavirus vaccine doses at standard and prolonged intervals. Vaccine 2018; 36:881-889. [PMID: 29306506 DOI: 10.1016/j.vaccine.2017.12.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/21/2017] [Accepted: 12/07/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The originally recommended dosing schedule, 0, 2, 6 months, for the 3-dose quadrivalent human papillomavirus vaccine (4vHPV) was often not followed, resulting in longer than recommended intervals between doses and interest in the effect of prolonged intervals. Recent two-dose recommendations require investigations into the effect of delaying dose 2. METHODS This multi-site, prospective study enrolled healthy 9-17 year old girls (n = 1321) on the day of or within 28 days following a third dose of 4vHPV vaccination. Antibody titers to 4vHPV types were measured at one and six months post-dose 3 from all participants and post-dose 2 from participants who were on time for dose 3. To compare antibody responses, participants were categorized into groups: second and third doses on time (control group); on-time dose 2, substantially late dose 3 (group 2); substantially late dose 2, on-time dose 3 (group 3); both doses substantially late (group 4). Analyses compared age-adjusted geometric mean titers (GMTs) at one-month and six-months post-dose 3, effect of delaying the second dose, and two versus three doses as well as post-dose 2 GMTs, stratified by age. RESULTS Compared to on-time dosing, one-month post-dose 3 GMTs were non-inferior in groups 2, 3, and 4 and were superior in group 2. Six month post-dose 3 GMTs were superior in groups 2, 3, and 4 for each genotype, except HPV 18 in group 3. Age-adjusted post does 2 titers were significantly lower than post-dose 3 titers when dose 2 was on time but were significantly higher when dose 2 was substantially late. Participants ≥15 years old had no difference in post-dose 2 titers compared to <15 year olds when dose 2 was substantially delayed. CONCLUSIONS Prolonged intervals between doses do not appear to diminish and may enhance antibody response to 4vHPV. ClinicalTrials.gov (NCT00524745).
Collapse
Affiliation(s)
- Lea E Widdice
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4000, Cincinnati, OH 45229, United States.
| | - Elizabeth R Unger
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Gitika Panicker
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, United States.
| | - Rebecca Hoagland
- Cota Enterprises, Inc., 16570 46th Street, McLouth, KS 66054, United States.
| | - S Todd Callahan
- Division of Adolescent and Young Adult Health, Vanderbilt University, 719 Thompson Lane, Suite 36300, Nashville, TN 37204, United States.
| | - Lisa A Jackson
- Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, United States.
| | - Andrea A Berry
- Division of Infectious Disease and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Karen Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, 685 W. Baltimore Street, HSF 480, Baltimore, MD 21201, United States.
| | - Sharon E Frey
- Division of Infectious Diseases, Allergy and Immunology, Saint Louis University, 1100 S. Grand Boulevard, St. Louis, MO 63104, United States.
| | - Christopher J Harrison
- Division of Pediatric Infectious Diseases, Children's Mercy - Kansas City, 2401 Gillham Road, MO 64108, United States.
| | - Barbara A Pahud
- Division of Pediatric Infectious Diseases, Children's Mercy - Kansas City, 2401 Gillham Road, MO 64108, United States.
| | - Kathryn M Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt Vaccine Research Program, D7227 Medical Center North, Vanderbilt University School of Medicine, Nashville, TN 37232, United States.
| | - Mark J Mulligan
- The Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 500 Irvin Court, Suite 200, Decatur, GA 30030, United States.
| | - Jon Sudman
- Kaiser Permanente Georgia, 200 Crescent Centre Parkway, Lower Level, Tucker, GA 30084, United States.
| | - David I Bernstein
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 6014, Cincinnati, OH 45229, United States.
| |
Collapse
|
20
|
F L, E H, A P, I U, K S, P S, L AD. Timing of two versus three doses of quadrivalent HPV vaccine and associated effectiveness against condyloma in Sweden: a nationwide cohort study. BMJ Open 2017; 7:e015021. [PMID: 28600369 PMCID: PMC5734289 DOI: 10.1136/bmjopen-2016-015021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To assess incidence of condyloma after two doses of quadrivalent human papillomavirus (qHPV) vaccine, by time since first vaccine dose, in girls and women initiating vaccination before age 20 years. DESIGN Register-based nationwide open cohort study. SETTING Sweden. PARTICIPANTS Girls and women initiating qHPV vaccination before age 20 years between 2006 and 2012. The study cohort included 264 498 girls, of whom 72 042 had received two doses of qHPV vaccine and 185 456 had received all three doses. MAIN OUTCOME MEASURE Incidence rate ratios (IRRs) of condyloma estimated by time between first and second doses of qHPV in months (m) and age at vaccination, adjusted for attained age. RESULTS For girls first vaccinated with two doses before the age of 17 years, the IRR of condyloma for 0-3 months between the first and second doses was 1.96 (95% CI 1.43 to 2.68) as compared with the standard three-dose schedule. The IRRs were 1.27 (95% CI 0.63 to 2.58) and 4.36 (95% CI 2.05 to 9.28) after receipt of two doses with 4-7 months and 8+ months between doses, respectively. For women first vaccinated after the age of 17 years, vaccination with two doses of qHPV vaccine and 0-3 months between doses was associated with an IRR of 2.12 (95% CI 1.62 to 2.77). For an interval of 4-7 months between doses, the IRR did not statistically significantly differ to the standard three-dose schedule (IRR=0.81, 95% CI 0.36 to 1.84). For women with 8+ months between dose 1 and dose 2 the IRR was 3.16 (95% CI 1.40 to 7.14). CONCLUSION A two-dose schedule for qHPV vaccine with 4-7 months between the first and second doses may be as effective against condyloma in girls and women initiating vaccination under 20 years as a three-dose schedule. Results from this nationwide study support immunogenicity data from clinical trials.
Collapse
Affiliation(s)
- Lamb F
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Herweijer E
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ploner A
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Uhnoo I
- Public Health Agency of Sweden, Solna, Stockholm, Sweden
| | - Sundström K
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sparén P
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arnheim-Dahlström L
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
21
|
Petersen LK, Restrepo J, Moreira ED, Iversen OE, Pitisuttithum P, Van Damme P, Joura EA, Olsson SE, Ferris D, Block S, Giuliano AR, Bosch X, Pils S, Cuzick J, Garland SM, Huh W, Kjaer SK, Bautista OM, Hyatt D, Maansson R, Moeller E, Qi H, Roberts C, Luxembourg A. Impact of baseline covariates on the immunogenicity of the 9-valent HPV vaccine - A combined analysis of five phase III clinical trials. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2017; 3:105-115. [PMID: 28720442 PMCID: PMC5883201 DOI: 10.1016/j.pvr.2017.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 02/02/2017] [Accepted: 03/13/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND The immunogenicity profile of the 9-valent HPV (9vHPV) vaccine was evaluated across five phase III clinical studies conducted in girls and boys 9-15 years of age and young women 16-26 years of age. The effect of baseline characteristics of subjects on vaccine-induced HPV antibody responses was assessed. METHODS Immunogenicity data from 11,304 subjects who received ≥1 dose of 9vHPV vaccine in five Phase III studies were analyzed. Vaccine was administered as a 3-dose regimen. HPV antibody titers were assessed 1 month after dose 3 using a competitive Luminex immunoassay and summarized as geometric mean titers (GMTs). Covariates examined were age, gender, race, region of residence, and HPV serostatus and PCR status at day 1. RESULTS GMTs to all 9 vaccine HPV types decreased with age at vaccination initiation, and were otherwise generally similar among the demographic subgroups defined by gender, race and region of residence. For all subgroups defined by race or region of residence, GMTs were higher in girls and boys than in young women. Vaccination of subjects who were seropositive at day 1 to a vaccine HPV type resulted in higher GMTs to that type, compared with those in subjects who were seronegative for that type at day 1. CONCLUSIONS 9vHPV vaccine immunogenicity was robust among subjects with differing baseline characteristics. It was generally comparable across subjects of different races and from different regions. Greater immunogenicity in girls and boys versus young women (the population used to establish 9vHPV vaccine efficacy in clinical studies) indicates that the anti-HPV responses generated by the vaccine in adolescents from all races or regions were sufficient to induce high-level protective efficacy. This immunogenicity profile supports a widespread 9vHPV vaccination program and early vaccination.
Collapse
Affiliation(s)
- Lone K Petersen
- Aarhus University Hospital, Department of Obstetrics and Gynecology, Aarhus, Denmark
| | - Jaime Restrepo
- Fundación Centro de Investigación Clínica CIC, Medellín, Colombia
| | - Edson D Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil
| | - Ole-Erik Iversen
- Department of Clinical Science, University of Bergen and Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway
| | | | - Pierre Van Damme
- Center for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium
| | - Elmar A Joura
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | | | - Daron Ferris
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, GA, USA
| | - Stan Block
- Kentucky Pediatric and Adult Research, Inc., Bardstown, KY, USA
| | | | | | - Sophie Pils
- Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, London, UK
| | - Suzanne M Garland
- Royal Women's Hospital, University of Melbourne and Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Warner Huh
- Division of Gynecologic Oncology, University of Alabama, Birmingham, USA
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, Denmark
| | | | | | | | | | - Hong Qi
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | |
Collapse
|
22
|
Harper DM, DeMars LR. HPV vaccines - A review of the first decade. Gynecol Oncol 2017; 146:196-204. [PMID: 28442134 DOI: 10.1016/j.ygyno.2017.04.004] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 02/01/2023]
Abstract
Pre-adolescent girls (9-15years) have the option of receiving a two dose HPV vaccine series at either a six month or one year interval to provide protection from HPV 16, the most prevalent type associated with cervical cancers, as well as several other less prevalent types. This series of vaccinations is highly likely to protect her from HPV infection until she enters the routine screening program, whether that be primary HPV testing or a combination of HPV testing and cytology. The two dose program has been recommended by the World Health Organization (WHO) since 2015. For women 15years and older, the three dose vaccine schedule is still recommended. The past ten years of Gardasil use has provided evidence of reduced HPV 16/18 infections in countries where there has been high coverage. Gardasil9 has replaced Gardasil. Gardasil9 has the same rapid anti-HPV 18 and HPV45 titer loss as Gardasil did. Cervarix remains equivalent to Gardasil9 in the prevention of HPV infections and precancers of any HPV type; Cervarix also has demonstrated sustained high antibody titers for at least 10years. One dose of Cervarix provides protection against HPV 16/18 infection with robust antibody titers well above natural infection titers. This may offer the easiest and most cost effective vaccination program over time, especially in low and lower middle income countries. Cervical cancer screening must continue to control cancer incidence over the upcoming decades. Future studies of prophylactic HPV vaccines, as defined by the WHO, must demonstrate protection against six month type specific persistent infections, not actual cervical cancer precursor disease endpoints, such as cervical intraepithelial neoplasia grade 3 (CIN 3) or adenocarcinoma in situ (AIS). This simplifies and makes less expensive future comparative studies between existing and new generic vaccines.
Collapse
Affiliation(s)
- Diane M Harper
- School of Medicine, Departments of Family and Geriatric Medicine and Obstetrics and Gynecology, Speed School of Engineering, School of Public Health, Epidemiology and Population Health, Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, United States.
| | - Leslie R DeMars
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| |
Collapse
|
23
|
Murcia Lora JM, Esparza Encina ML, Alcázar Zambrano JL. Naprotecnología: ciencia y persona en la infección por el virus del papiloma humano (VPH) en mujeres y preadolescencentes. PERSONA Y BIOÉTICA 2017. [DOI: 10.5294/pebi.2017.21.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
En la actualidad hay suficiente evidencia científica que relaciona directamente adquisición, exposición y prevalencia del virus del papiloma humano (VPH) con el cáncer del cuello de uterino. Por ello, el artículo aborda el VPH en la mujer teniendo en cuenta la naprotecnología, que permite conjugar evidencia científica y planteamientos éticos. Se busca que se tengan en cuenta tanto el aspecto biológico de la sexualidad como la capacidad de hacerse persona en su núcleo sexual. De ahí que se analicen programas dirigidos a la educación sexual, basados tanto en la prevención sanitaria como en la antropología de la sexualidad, y apoyados por las instituciones familiares, que han demostrado una mejor acogida ante los riesgos de las enfermedades de transmisión sexual, y entre ellas la infección por el VPH.
Collapse
|
24
|
Schlecht NF, Diaz A, Shankar V, Szporn AH, Wu M, Nucci-Sack A, Peake K, Strickler HD, Burk RD. Risk of Delayed Human Papillomavirus Vaccination in Inner-City Adolescent Women. J Infect Dis 2016; 214:1952-1960. [PMID: 27738056 DOI: 10.1093/infdis/jiw486] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/06/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uptake of human papillomavirus (HPV) vaccine in the United States is slow, and the effectiveness of the vaccine has not been assessed in high-risk adolescent populations. METHODS We conducted a longitudinal study of 1139 sexually active, inner-city adolescent women receiving the 3-dose quadrivalent (4vHPV) vaccine. Cervical and anal specimens collected semiannually were tested using an L1-specific polymerase chain reaction assay. Postvaccination incidence of 4vHPV vaccine and nonvaccine HPV types, and risk of cervical cytological abnormalities, were assessed in relation to time to completion of all 3 vaccine doses. RESULTS Compared to vaccine naive women at enrollment, vaccinated women had significantly lower incidence rate ratios of cervical infection with HPV6/11/16/18 (0.2; 95% confidence interval [CI], .1-.4) and the related types HPV31 and HPV45 (0.4 [95% CI, .2-1.0] and 0.3 [95% CI, .1-.6], respectively), as well as significantly lower incidence rate ratios of anal infection with HPV6/11/16/18 (0.4; 95% CI, .2-.7). Notably, we observed higher risks of cervical HPV6/11/16/18 infection (hazards ratio [HR], 2.9; 95% CI, 1.0-8.0) and associated cytological abnormalities (HR, 4.5; 95% CI, .7-26.0) among women immunized at ≥15 years of age who took ≥12 months (vs <12 months) to complete the 3-dose regimen. CONCLUSIONS Among adolescents immunized at ≥15 years of age, a longer time to complete the 3-dose schedule was associated with an increased risk of anogenital HPV6/11/16/18 infection and an increased incidence of associated cervical cytological abnormalities.
Collapse
Affiliation(s)
| | - Angela Diaz
- Mount Sinai Adolescent Health Center.,Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | | | - Arnold H Szporn
- Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | - Maoxin Wu
- Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | - Anne Nucci-Sack
- Mount Sinai Adolescent Health Center.,Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | - Ken Peake
- Mount Sinai Adolescent Health Center.,Icahn School of Medicine at Mount Sinai, Manhattan, New York
| | | | | |
Collapse
|
25
|
Seña AC, Hsu KK, Kellogg N, Girardet R, Christian CW, Linden J, Griffith W, Marchant A, Jenny C, Hammerschlag MR. Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children. Clin Infect Dis 2016; 61 Suppl 8:S856-64. [PMID: 26602623 DOI: 10.1093/cid/civ786] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.
Collapse
Affiliation(s)
- Arlene C Seña
- Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Katherine K Hsu
- Division of STD Prevention, Bureau of Infectious Diseases, Massachusetts Department of Public Health, Jamaica Plain
| | - Nancy Kellogg
- Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio
| | - Rebecca Girardet
- Division of Child Protection Pediatrics, Department of Pediatrics, University of Texas Health Science Center at Houston
| | - Cindy W Christian
- Child Abuse and Neglect Prevention, Children's Hospital of Philadelphia, Pennsylvania
| | - Judith Linden
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston
| | - William Griffith
- Women's Emergency Services, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Anne Marchant
- Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston
| | - Carole Jenny
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle
| | - Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn
| |
Collapse
|
26
|
Nagpal J, Linares LO, Weiss J, Schlecht NF, Shankar V, Braun-Courville D, Nucci-Sack A, Strickler HD, Burk RD, Diaz A. Knowledge about Human Papillomavirus and Time to Complete Vaccination among Vulnerable Female Youth. J Pediatr 2016; 171:122-7. [PMID: 26846571 PMCID: PMC4808615 DOI: 10.1016/j.jpeds.2015.12.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/23/2015] [Accepted: 12/28/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the association of knowledge about human papillomavirus (HPV) on the time to completion of the 3-dose quadrivalent vaccine series in an inner-city population of adolescent female subjects at high risk for infection. STUDY DESIGN We prospectively followed 139 female subjects aged 14-20 years enrolled in a vaccine surveillance study in New York City during a period of at least 24 months. Participants were given a 30-item true or false survey on HPV at enrollment and ranked according to the number of correct responses. Multivariate Cox regression was used to examine the association between level of knowledge about HPV and time to completion (in days) of vaccine dose 1-3, dose 1-2, and dose 2-3. RESULTS Overall time to completion of the 3-dose vaccine ranged from 158 days to 1114 days. Participants in the high knowledge group (top quartile) were significantly more likely to complete the 3-dose series earlier (hazard ratio 1.69, 95% CI 1.03-2.77; P = .04), in particular doses 2-3 (hazard ratio 1.71, 95% CI 1.02-2.89; P = .04), than those with low-to-moderate knowledge (bottom 3 quartiles). CONCLUSIONS These findings suggest that knowledge of HPV is associated with shorter time to complete the 3-dose HPV vaccine series. Educational campaigns at time of vaccination may be important to improve vaccine adherence.
Collapse
Affiliation(s)
- Julie Nagpal
- Department of Pediatrics, The Mount Sinai Medical Center, New York, NY.
| | | | - Jocelyn Weiss
- Department of Pediatrics, The Mount Sinai Medical Center, New York, NY
| | - Nicolas F Schlecht
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; Departments of Pediatrics, Microbiology & Immunology, and Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY
| | - Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | | | - Anne Nucci-Sack
- Department of Pediatrics, The Mount Sinai Medical Center, New York, NY
| | - Howard D Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Angela Diaz
- Department of Pediatrics, The Mount Sinai Medical Center, New York, NY
| |
Collapse
|
27
|
Puthanakit T, Huang LM, Chiu CH, Tang RB, Schwarz TF, Esposito S, Frenette L, Giaquinto C, McNeil S, Rheault P, Durando P, Horn M, Klar M, Poncelet S, De Simoni S, Friel D, De Muynck B, Suryakiran PV, Hezareh M, Descamps D, Thomas F, Struyf F. Randomized Open Trial Comparing 2-Dose Regimens of the Human Papillomavirus 16/18 AS04-Adjuvanted Vaccine in Girls Aged 9-14 Years Versus a 3-Dose Regimen in Women Aged 15-25 Years. J Infect Dis 2016; 214:525-36. [PMID: 26908726 PMCID: PMC4957434 DOI: 10.1093/infdis/jiw036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/11/2016] [Indexed: 11/14/2022] Open
Abstract
Background. This randomized, open trial compared regimens including 2 doses (2D) of human papillomavirus (HPV) 16/18 AS04-adjuvanted vaccine in girls aged 9–14 years with one including 3 doses (3D) in women aged 15–25 years. Methods. Girls aged 9–14 years were randomized to receive 2D at months 0 and 6 (M0,6; (n = 550) or months 0 and 12 (M0,12; n = 415), and women aged 15–25 years received 3D at months 0, 1, and 6 (n = 482). End points included noninferiority of HPV-16/18 antibodies by enzyme-linked immunosorbent assay for 2D (M0,6) versus 3D (primary), 2D (M0,12) versus 3D, and 2D (M0,6) versus 2D (M0,12); neutralizing antibodies; cell-mediated immunity; reactogenicity; and safety. Limits of noninferiority were predefined as <5% difference in seroconversion rate and <2-fold difference in geometric mean antibody titer ratio. Results. One month after the last dose, both 2D regimens in girls aged 9–14 years were noninferior to 3D in women aged 15–25 years and 2D (M0,12) was noninferior to 2D (M0,6). Geometric mean antibody titer ratios (3D/2D) for HPV-16 and HPV-18 were 1.09 (95% confidence interval, .97–1.22) and 0.85 (.76–.95) for 2D (M0,6) versus 3D and 0.89 (.79–1.01) and 0.75 (.67–.85) for 2D (M0,12) versus 3D. The safety profile was clinically acceptable in all groups. Conclusions. The 2D regimens for the HPV-16/18 AS04-adjuvanted vaccine in girls aged 9–14 years (M0,6 or M0,12) elicited HPV-16/18 immune responses that were noninferior to 3D in women aged 15–25 years. Clinical Trials Registration. NCT01381575.
Collapse
Affiliation(s)
- Thanyawee Puthanakit
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Li-Min Huang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Kweishan, Taoyuan
| | - Ren-Bin Tang
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tino F Schwarz
- Central Laboratory and Vaccination Centre, Stiftung Juliusspital, Würzburg, Germany
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Cá Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Carlo Giaquinto
- Dipartimento di Pediatria, Azienda Ospedaliera Universitaria di Padova, Italy
| | - Shelly McNeil
- Canadian Center for Vaccinology, IWK Health Centre and NovaScotia Health Authority, Dalhousie University, Halifax
| | | | - Paolo Durando
- Department of Health Sciences, School of Medical and Pharmaceutical Sciences, Vaccines and Clinical Trials Unit, IRCCS AOU San Martino-IST, University of Genoa, Italy
| | | | - Maximilian Klar
- Department of Obstetrics and Gynecology, Freiburg Medical School, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Sankaranarayanan R, Prabhu PR, Pawlita M, Gheit T, Bhatla N, Muwonge R, Nene BM, Esmy PO, Joshi S, Poli URR, Jivarajani P, Verma Y, Zomawia E, Siddiqi M, Shastri SS, Jayant K, Malvi SG, Lucas E, Michel A, Butt J, Vijayamma JMB, Sankaran S, Kannan TPRA, Varghese R, Divate U, Thomas S, Joshi G, Willhauck-Fleckenstein M, Waterboer T, Müller M, Sehr P, Hingmire S, Kriplani A, Mishra G, Pimple S, Jadhav R, Sauvaget C, Tommasino M, Pillai MR. Immunogenicity and HPV infection after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre prospective cohort study. Lancet Oncol 2016; 17:67-77. [PMID: 26652797 PMCID: PMC5357737 DOI: 10.1016/s1470-2045(15)00414-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/02/2015] [Accepted: 10/08/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND An increase in worldwide HPV vaccination could be facilitated if fewer than three doses of vaccine are as effective as three doses. We originally aimed to compare the immunogenicity and frequency of persistent infection and cervical precancerous lesions caused by vaccine-targeted HPV after vaccination with two doses of quadrivalent vaccine on days 1 and 180 or later, with three doses on days 1, 60, and 180 or later, in a cluster-randomised trial. Suspension of the recruitment and vaccination due to events unrelated to our study meant that some enrolled girls could not be vaccinated and some vaccinated girls received fewer than the planned number of vaccinations by default. As a result, we re-analysed our data as an observational cohort study. METHODS Our study was designed to be done in nine locations (188 clusters) in India. Participants were unmarried girls aged 10-18 years vaccinated in four cohorts: girls who received three doses of vaccine on days 1, 60, and 180 or later, two doses on days 1 and 180 or later, two doses on days 1 and 60 by default, and one dose by default. The primary outcomes were immunogenicity in terms of L1 genotype-specific binding antibody titres, neutralising antibody titres, and antibody avidity after vaccination for the vaccine-targeted HPV types 16, 18, 6, and 11 and incident and persistent infections with these HPVs. Analysis was per actual number of vaccine doses received. This study is registered with ISRCTN, number ISRCTN98283094; and with ClinicalTrials.gov, number NCT00923702. FINDINGS Vaccination of eligible girls was initiated on Sept 1, 2009, and continued until April 8, 2010. Of 21 258 eligible girls identified at 188 clusters, 17 729 girls were recruited from 178 clusters before suspension. 4348 (25%) girls received three doses, 4979 (28%) received two doses on days 1 and 180 or later, 3452 (19%) received two doses at days 1 and 60, and 4950 (28%) received one dose. Immune response in the two-dose HPV vaccine group was non-inferior to the three-dose group (median fluorescence intensity ratio for HPV 16 1·12 [95% CI 1·02-1·23] and for HPV 18 1·04 [0·92-1·19]) at 7 months, but was inferior in the two-dose default (0·33 [0·29-0·38] for HPV 16 and 0·51 [0·43-0·59] for HPV 18) and one-dose default (0·09 [0·08-0·11] for HPV 16 and 0·12 [0·10-0·14] for HPV 18) groups at 18 months. The geometric mean avidity indices after fewer than three doses by design or default were non-inferior to those after three doses of vaccine. Fewer than three doses by design and default induced detectable concentrations of neutralising antibodies to all four vaccine-targeted HPV types, but at much lower concentration after one dose. Cervical samples from 2649 participants were tested and the frequency of incident HPV 16, 18, 6, and 11 infections was similar irrespective of the number of vaccine doses received. The testing of at least two samples from 838 participants showed that there was no persistent HPV 16 or 18 infections in any study group at a median follow-up of 4·7 years (IQR 4·2-5·1). INTERPRETATION Despite the limitations imposed by the suspension of the HPV vaccination, our findings lend support to the WHO recommendation of two doses, at least 6 months apart, for routine vaccination of young girls. The short-term protection afforded by one dose of HPV vaccine against persistent infection with HPV 16, 18, 6, and 11 is similar to that afforded by two or three doses of vaccine and merits further assessment. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Rengaswamy Sankaranarayanan
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France.
| | - Priya Ramesh Prabhu
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, Kerala, India
| | - Michael Pawlita
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany
| | - Tarik Gheit
- Infections and Cancer Biology Group, Infections Section, International Agency for Research on Cancer, Lyon, France
| | - Neerja Bhatla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Richard Muwonge
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Bhagwan M Nene
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi, Solapur District, Maharashtra, India
| | | | - Smita Joshi
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune, India
| | - Usha Rani Reddy Poli
- Mehdi Nawaj Jung Institute of Oncology and Regional Cancer Center, Red Hills, Lakadikapul, Hyderabad, Andhra Pradesh, India
| | - Parimal Jivarajani
- Health Care Global Cancer Centre, Sola-Science City Road, Near Sola Bridge, Ahmedabad, Gujarat, India
| | - Yogesh Verma
- Sir Thodup Namgyal Memorial Hospital/Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | | | | | - Surendra S Shastri
- Department of Preventive Oncology, Tata Memorial Center, Parel, Mumbai, India
| | - Kasturi Jayant
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi, Solapur District, Maharashtra, India
| | - Sylla G Malvi
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi, Solapur District, Maharashtra, India
| | - Eric Lucas
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Angelika Michel
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany
| | - Julia Butt
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany
| | | | - Subha Sankaran
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, Kerala, India
| | | | - Rintu Varghese
- Rajiv Gandhi Centre for Biotechnology, Poojappura, Thiruvananthapuram, Kerala, India
| | - Uma Divate
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune, India
| | - Shila Thomas
- Christian Fellowship Community Health Centre, Ambillikai, Tamil Nadu, India
| | - Geeta Joshi
- Gujarat Cancer and Research Institute, M P Shah Cancer Hospital, Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Martina Willhauck-Fleckenstein
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany
| | - Tim Waterboer
- Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany
| | - Martin Müller
- Tumorvirus-specific Vaccination Strategies, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), Im Neuenheimer Feld, Heidelberg, Germany
| | - Peter Sehr
- EMBL-DKFZ Chemical Biology Core Facility, European Molecular Biology Laboratory, Heidelberg, Germany
| | - Sanjay Hingmire
- Tata Memorial Centre Rural Cancer Project, Nargis Dutt Memorial Cancer Hospital, Barshi, Solapur District, Maharashtra, India
| | - Alka Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Gauravi Mishra
- Department of Preventive Oncology, Tata Memorial Center, Parel, Mumbai, India
| | - Sharmila Pimple
- Department of Preventive Oncology, Tata Memorial Center, Parel, Mumbai, India
| | - Radhika Jadhav
- Jehangir Clinical Development Centre, Jehangir Hospital Premises, Pune, India
| | - Catherine Sauvaget
- Screening Group, Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - Massimo Tommasino
- Infections and Cancer Biology Group, Infections Section, International Agency for Research on Cancer, Lyon, France
| | | |
Collapse
|
29
|
Abstract
SUMMARYHuman papillomavirus (HPV) is the necessary cause of cervical cancer, the fourth most common cancer and cause of cancer-related death in females worldwide. HPV also causes anal, vaginal, vulvar, penile, and oropharyngeal cancer. Prophylactic HPV vaccines based on recombinantly expressed virus-like particles have been developed. Two first-generation, U.S. Food and Drug Administration (FDA)-approved vaccines prevent infections and disease caused by HPV16 and HPV18, the two HPV genotypes that cause approximately 70% of cervical cancer, and one of these vaccines also prevents HPV6 and HPV11, the two HPV genotypes that cause 90% of genital warts. A next-generation vaccine, recently approved by the U.S. FDA, targets HPV16, HPV18, and five additional HPV genotypes that together causes approximately 90% of cervical cancer as well as HPV6 and HPV11. In clinical trials, these vaccines have shown high levels of efficacy against disease and infections caused by the targeted HPV genotypes in adolescent females and males and older females. Data indicate population effectiveness, and therefore cost effectiveness, is highest in HPV-naive young females prior to becoming sexually active. Countries that implemented HPV vaccination before 2010 have already experienced decreases in population prevalence of targeted HPV genotypes and related anogenital diseases in women and via herd protection in heterosexual men. Importantly, after more than 100 million doses given worldwide, HPV vaccination has demonstrated an excellent safety profile. With demonstrated efficacy, cost-effectiveness, and safety, universal HPV vaccination of all young, adolescent women, and with available resources at least high-risk groups of men, should be a global health priority. Failure to do so will result in millions of women dying from avertable cervical cancers, especially in low- and middle-income countries, and many thousands of women and men dying from other HPV-related cancers.
Collapse
|
30
|
Hernández-Ávila M, Torres-Ibarra L, Stanley M, Salmerón J, Cruz-Valdez A, Muñoz N, Herrero R, Villaseñor-Ruíz IF, Lazcano-Ponce E. Evaluation of the immunogenicity of the quadrivalent HPV vaccine using 2 versus 3 doses at month 21: An epidemiological surveillance mechanism for alternate vaccination schemes. Hum Vaccin Immunother 2015; 12:30-8. [PMID: 26211489 PMCID: PMC4962716 DOI: 10.1080/21645515.2015.1058458] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/14/2015] [Accepted: 06/01/2015] [Indexed: 12/17/2022] Open
Abstract
The cost of HPV vaccines and the need for 3 doses remains a barrier for their inclusion in routine vaccination schedules for girls in low and middle income countries. In a non-inferiority study, we aimed to compare the immunogenicity of a standard 3 doses and a 2 doses schedule. We enrolled 450 participants in an open-label non-randomized clinical trial to evaluate the immunogenicity induced at different ages by the licensed HPV6/11/16/18 quadrivalent vaccine in a 2 doses schedule (0-6 months, n = 150 girls aged 9-10 y) and 3 doses schedule (0, 2, and 6 months; n = 150 girls aged 9-10 y and n=150 women aged 18 to 24 years). To assess the antibody response, blood samples were obtained at Month 7 and 21 after the first vaccination from participants in all study groups. cLIA testing was performed at Merck Research Laboratories. Antibody levels were expressed as milli-Merck units (mMU) per ml. Primary outcome was non-inferiority (95% CI, lower bound >0.5) of the geometric mean titers (GMT) ratios for HPV6, HPV11, HPV16 and HPV18 antibodies 7 and 21 months after the first dose among girls receiving 2 doses compared with young women and girls receiving 3 doses. All vaccinees were seropositive for both HPV16 and HPV18 antibodies at month 7. At month 21, 98.5 and 56.6% of women 18-24 y old were seropositive for HPV16 and 18, respectively. For girls in the three doses group, seropositivity rates were 99.3 and 86.3% for HPV16 and 18, respectively. For girls in the two doses group rates were 99.3 and 70.2% for HPV16 and 18, respectively. The two doses schedule was non-inferior compared to the 3 doses schedule in same-age girls and to the group of adult women after 21 months of the first vaccine dose. Our results are in agreement with similar trials evaluating the immune response of a 2 doses schedule of both HPV vaccines, supporting the recent WHO recommendation as well as the Mexican policy to incorporate the 2 doses schedule for girls aged 9-11 y.
Collapse
Affiliation(s)
- Mauricio Hernández-Ávila
- Center for Population Health Research; National Institute of Public Health; Cuernavaca, Morelos, Mexico
| | - Leticia Torres-Ibarra
- Center for Population Health Research; National Institute of Public Health; Cuernavaca, Morelos, Mexico
| | | | - Jorge Salmerón
- Center for Population Health Research; National Institute of Public Health; Cuernavaca, Morelos, Mexico
- Unidad de Investigación Epidemiológica y en Servicios de Salud; Instituto Mexicano del Seguro Social; Cuernavaca, Morelos, México
| | - Aurelio Cruz-Valdez
- Center for Population Health Research; National Institute of Public Health; Cuernavaca, Morelos, Mexico
| | - Nubia Muñoz
- National Institute of Cancer; Bogotá, Colombia
| | | | | | - Eduardo Lazcano-Ponce
- Center for Population Health Research; National Institute of Public Health; Cuernavaca, Morelos, Mexico
| |
Collapse
|
31
|
Vaccines against human papillomavirus in low and middle income countries: a review of safety, immunogenicity and efficacy. Infect Agent Cancer 2015; 10:17. [PMID: 26075018 PMCID: PMC4465311 DOI: 10.1186/s13027-015-0012-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/21/2015] [Indexed: 12/13/2022] Open
Abstract
Currently, there is limited data on the immunogenicity and efficacy of human papillomavirus vaccines in Low and Middle income countries (LMIC). The review aims to summarize the current status from published HPV vaccine safety, immunogenicity and efficacy studies in low and middle income countries (LMIC). Electronic databases (PubMed/MEDLINE and HINARI) were searched for peer reviewed English language articles on HPV vaccination in LMIC that have so far been published from 1st January 2006 up to 30th January 2015. Eligible studies were included if they had used the bivalent (bHPV) or quadrivalent HPV (qHPV) vaccines in a LMIC and investigated safety, immunogenicity and/or efficacy. The main findings were extracted and summarized. A total of fourteen HPV vaccine studies assessing safety, Immunogenicity and efficacy of the bivalent or quadrivalent vaccines in LMIC were included. There are only ten published clinical trials where a LMIC has participated. There was no published study so far that assessed efficacy of the HPV vaccines in Sub-Saharan Africa. From these studies, vaccine induced immune response was comparable to that from results of HICs for all age groups. Studies assessing HPV vaccine efficacy of the bivalent or quadrivalent vaccine within LMIC were largely missing. Only three studies were found where a LMIC was part of a multi center clinical trial. In all the studies, there were no vaccine related serious adverse events. The findings from the only study that investigated less than three doses of the bivalent HPV-16/18 vaccine suggest that even with less than three doses, antibody levels were still comparable with older women where efficacy has been proven. The few studies from LMIC in this review had comparable safety, Immunogenicity and efficacy profiles like in HIC. Overall, the LMIC of Africa where immune compromising/modulating situations are prevalent, there is need for long term immunogenicity as well as surveillance studies for long term clinical effectiveness after two and three dose regimens.
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW To provide a clinically relevant synopsis of the latest research and recommendations regarding adolescent immunizations. RECENT FINDINGS Immunization is an important and effective strategy for preventing morbidity and mortality in adolescents. Although there has been progress in recent years, coverage rates in the US remain suboptimal, particularly for the human papillomavirus vaccine. Much work has been done to better understand and address the barriers to adolescent immunization, so that all teens may be protected against serious vaccine-preventable diseases. In addition, several recent studies have focused on the effectiveness of current adolescent vaccines and the development of new vaccines to protect against additional types of human papillomavirus and serotype B Neisseria meningitidis. Decreased pertussis vaccine effectiveness has led to new recommendations for pregnant women, including adolescents, to protect them and their young infants. The present review highlights selected literature on acellular pertussis, meningococcal, and human papillomavirus vaccines. Research findings on various strategies to improve adolescent vaccine uptake are also discussed in this review. SUMMARY Research on adolescent immunizations and their delivery continues to have an impact on clinical practice and will shape future guidelines. Through this work, we can learn how best to protect adolescents against vaccine-preventable diseases.
Collapse
|
33
|
Stuijver DJF, Romualdi E, van Zaane B, Bax L, Büller HR, Gerdes VEA, Squizzato A. Under-reporting of venous and arterial thrombotic events in randomized clinical trials: a meta-analysis. Intern Emerg Med 2015; 10:219-46. [PMID: 25502591 DOI: 10.1007/s11739-014-1168-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/27/2014] [Indexed: 01/11/2023]
Abstract
For the detection of unwanted outcomes of new interventions, physicians rely on adverse event reporting. We attempt to quantify the reported incidence of venous thromboembolism (VTE) and arterial thrombosis (AT) in randomized clinical trials (RCTs), and evaluate the extent of under-reporting. We selected all therapeutic RCTs published in the four highest-impact general medicine journals between January 2011 and July 2011. Patients were categorized according to VTE risk. The occurrences of VTE and AT, either as predefined outcome or adverse event, were assessed. We identified 131 RCTs. VTE and AT were not reported in 89 and 70 % of these studies, respectively. The raw-unweighted reported incidence in the 3 studies with predefined outcomes for VTE was 8.4 (7.8-9.1) per 1,000 person-years. In the 128 studies without predefined outcomes for VTE, (consisting of 322,029 individuals, including patients with cancer, inflammatory disease, cardiovascular disease, surgery, adding up to a follow-up >500,000 person-years), an incidence of 0.4 (0.4-0.5) per 1,000 person-years was found. The reported incidence of AT in 18 studies in which AT was part of predefined outcomes was 25.6 (24.9-26.3) per 1,000 person-years. In 92 studies without predefined outcomes for AT (231,638 individuals, follow-up >200,000 person-years,), the incidence was 2.5 (2.3-2.7) per 1,000 person-years. The incidence of VTE and AT in RCTs is highly under-reported. Uniform registration of adverse events, even when unlikely to be related to the intervention, is necessary to be able to inform physicians about the potential toxicities of new therapeutic strategies.
Collapse
Affiliation(s)
- Danka J F Stuijver
- Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
34
|
Lim WT, Sears K, Smith LM, Liu G, Lévesque LE. Evidence of effective delivery of the human papillomavirus (HPV) vaccine through a publicly funded, school-based program: the Ontario Grade 8 HPV Vaccine Cohort Study. BMC Public Health 2014; 14:1029. [PMID: 25278003 PMCID: PMC4198791 DOI: 10.1186/1471-2458-14-1029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 09/11/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Proper administration of the human papillomavirus (HPV) vaccine (three doses at 0, 2, and 6 months) will likely influence the vaccine's effectiveness and the impact of vaccination programs on health outcomes. Therefore, we assessed HPV vaccine series completion and on-time dosing in Canada's largest publicly funded, school-based HPV vaccination program. METHODS Using administrative health and immunization databases, we identified a population-based cohort of girls eligible for Ontario's Grade 8 HPV vaccination program in the 2007/08-2009/10 program years who received at least one dose of the vaccine. We determined the number of doses received and calculated the percentage of girls that completed the three-dose series in Grade 8 and Grades 8-9. To assess on-time dosing, the number of days between doses 1-2, 2-3, and 1-3 was calculated and categorized (e.g., too short, on schedule, too long) based on the manufacturer's recommendations. Analyses were also stratified by program year. RESULTS We identified a cohort of 55,798 girls who initiated the vaccination series. Series completion was high in the Grade 8 window (81.8%) and increased by approximately 6% in Grade 9. Series completion was similar across the three program years. 70.8%, 98.5%, and 86.1% of girls were classified as 'on schedule' for dosing intervals 1-2, 2-3, and 1-3, respectively; 70.0% of girls received all three doses in perfect accordance with dosing recommendations. Stratification revealed that on-time dosing was highest in the first two years of the program (85.6% and 80.6%), but dropped to 42.1% in the 2009/10 year when H1N1 vaccination programs were prioritized. CONCLUSIONS Our study demonstrates that delivery of the HPV vaccine through a free, school-based program is an effective method of ensuring high completion and on-time dosing, but may not be sufficient to guarantee high coverage.
Collapse
Affiliation(s)
- W Ting Lim
- />Department of Public Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
- />Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
| | - Kim Sears
- />School of Nursing, Queen’s University, Kingston, K7L 3N6 Canada
| | - Leah M Smith
- />Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, H3A 1A2 Canada
| | - Guoyuan Liu
- />Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
| | - Linda E Lévesque
- />Department of Public Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
- />Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, Ontario K7L 3N6 Canada
| |
Collapse
|
35
|
Immunogenicity of bivalent HPV vaccine among partially vaccinated young adolescent girls in Uganda. Vaccine 2014; 32:6303-11. [DOI: 10.1016/j.vaccine.2014.08.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/16/2014] [Accepted: 08/27/2014] [Indexed: 11/21/2022]
|
36
|
Harper DM, Else BM, Bartley MJ, Arey AM, Barnett AL, Rosemergey BE, Paynter CA, Verdenius I, Harper SM, Harris GD, Groner JA, Malnar GJ, Wall J, Bonham AJ. In a safety net population HPV4 vaccine adherence worsens as BMI increases. PLoS One 2014; 9:e103172. [PMID: 25076128 PMCID: PMC4116139 DOI: 10.1371/journal.pone.0103172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
Objectives Obesity adversely inhibits antibody response to vaccination. Three doses of HPV4 may or may not provide adequate long term protection against HPV 16/18 in obese females. The aim of this study was to determine whether adherence to HPV4 vaccination in a safety net population was reduced with increasing body mass index (BMI). Methods We designed a historical prospective study evaluating the number and dates of HPV4 dosing that occurred from July 1, 2006 through October 1, 2009 by the demographic characteristics of the 10–26 year old recipient females. The defined dosing intervals were adapted from the literature and obesity categories were defined by the WHO. Results 1240 females with BMI measurements received at least one dose of HPV4; 38% were obese (class I, II and III) and 25% were overweight. Females with normal BMI received on-time triplet dosing significantly more often than did the obese class II and III females (30% vs. 18%, p<0.001). Obese class II/III females have a significant 45% less chance of completing the on-time triplet HPV4 series than normal women (OR = 0.55, 95% CI: 0.37, 0.83). Pregnancy history has a significant influence on BMI and HPV4 dosing compliance in this safety net population where 71% had been gravid. Hispanic females were less likely to complete HPV4 dosing regardless of BMI (aOR = 0.39, 95% CI: 0.16, 0.95). Conclusions Obesity, as well as gravidity and Hispanic race, are risk factors for lack of HPV4 vaccine adherence among young females in a safety net population.
Collapse
Affiliation(s)
- Diane M. Harper
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
- * E-mail:
| | - Britney M. Else
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Mitchell J. Bartley
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Anne M. Arey
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Angela L. Barnett
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Beth E. Rosemergey
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Christopher A. Paynter
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Inge Verdenius
- Department of Obstetrics and Gynecology, Radboud University, Nijmegen, the Netherlands
| | - Sean M. Harper
- Hampshire College, Amherst, Massachusetts, United States of America
| | - George D. Harris
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jennifer A. Groner
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Aaron J. Bonham
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| |
Collapse
|
37
|
LaMontagne DS. Reply to Harper. J Infect Dis 2014; 210:331-2. [DOI: 10.1093/infdis/jiu073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Harper DM. Conclusions About the Quadrivalent Human Papillomavirus Vaccine Efficacy Based on Alternate Dosing Schedules and Less Than Three Dose Immunogenicity is Inappropriate. J Infect Dis 2014; 210:330-1. [DOI: 10.1093/infdis/jiu072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Stanley MA, Sudenga SL, Giuliano AR. Alternative dosage schedules with HPV virus-like particle vaccines. Expert Rev Vaccines 2014; 13:1027-38. [PMID: 25001893 DOI: 10.1586/14760584.2014.935767] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HPV vaccines can prevent multiple cancers in women and men. Difficulties in the cost and completion of the three-dose vaccine series have led to considerations of alternative dose schedules. In clinical trials, three doses given within a 12-month period versus the standard 6-month period yielded comparable results, and immunogenicity appears comparable with two doses in adolescent females compared to the three-dose series in adult females. While the data are generally supportive of moving to a two-dose vaccine schedule among young female adolescents, the adoption of a two-dose vaccine schedule still poses a potential risk to the strength and longevity of the immune response. Public health authorities implementing a two-dose vaccine schedule should devise risk management strategies to minimize the potential impact on cancer prevention.
Collapse
|
40
|
Safaeian M, Porras C, Pan Y, Kreimer A, Schiller JT, Gonzalez P, Lowy DR, Wacholder S, Schiffman M, Rodriguez AC, Herrero R, Kemp T, Shelton G, Quint W, van Doorn LJ, Hildesheim A, Pinto LA. Durable antibody responses following one dose of the bivalent human papillomavirus L1 virus-like particle vaccine in the Costa Rica Vaccine Trial. Cancer Prev Res (Phila) 2014; 6:1242-50. [PMID: 24189371 DOI: 10.1158/1940-6207.capr-13-0203] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Costa Rica HPV16/18 Vaccine Trial (CVT) showed that four-year vaccine efficacy against 12-month HPV16/18 persistent infection was similarly high among women who received one, two, or the recommended three doses of the bivalent HPV16/18 L1 virus-like particle (VLP) vaccine. Live-attenuated viral vaccines, but not simple-subunit vaccines, usually induce durable lifelong antibody responses after a single dose. It is unclear whether noninfectious VLP vaccines behave more like live-virus or simple-subunit vaccines in this regard. To explore the likelihood that efficacy will persist longer term, we investigated the magnitude and durability of antibodies to this vaccine by measuring HPV16- and HPV18-specific antibodies by VLP-ELISA using serum from enrollment, vaccination, and annual visits through four years in four vaccinated groups; one-dose (n = 78), two-doses separated by one month (n = 140), two doses separated by six months (n = 52), and three scheduled doses (n = 120, randomly selected). We also tested enrollment sera from n = 113 HPV16- or HPV18 L1-seropositive women prevaccination, presumably from natural infection. At four years, 100% of women in all groups remained HPV16/18 seropositive; both HPV16/18 geometric mean titers (GMT) among the extended two-dose group were non-inferior to the three-dose group, and ELISA titers were highly correlated with neutralization titers in all groups. Compared with the natural infection group, HPV16/18 GMTs were, respectively, at least 24 and 14 times higher among the two-dose and 9 and 5 times higher among one-dose vaccinees. Antibody levels following one-dose remained stable from month 6 through month 48. Results raise the possibility that even a single dose of HPV VLPs will induce long-term protection.
Collapse
Affiliation(s)
- Mahboobeh Safaeian
- Division of Cancer Epidemiology and Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute, 9609 Medical Center Drive, Rm 6-E224, MSC 9767, Bethesda, MD 20892.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Sandri KJ, Verdenius I, Bartley MJ, Else BM, Paynter CA, Rosemergey BE, Harris GD, Malnar GJ, Harper SM, Griffith RS, Bonham AJ, Harper DM. Urban and rural safety net health care system clinics: no disparity in HPV4 vaccine completion rates. PLoS One 2014; 9:e96277. [PMID: 24816199 PMCID: PMC4015932 DOI: 10.1371/journal.pone.0096277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Safety net health care centers in the US serve vulnerable and underinsured females. The primary aim of this work was to determine if HPV4 dosing compliance differs between females who receive doses at rural vs. urban core safety net health care locations. METHODS Females exclusively receiving health care in the Truman Medical Center (TMC) safety net system at the urban core and rural locations were identified by their HPV4 vaccine records. Dates and number of HPV4 doses as well as age, gravidity, parity and race/ethnicity were recorded from the electronic medical record (EMR). Appropriate HPV4 dosing intervals were referenced from the literature. RESULTS 1259 females, 10-26 years of age, received HPV4 vaccination at either the rural (23%) or urban core location (77%). At the rural location, 23% received three doses on time, equal to the 24% at the urban core. Females seen in the urban core were more likely to receive on-time doublet dosing than on-time triplet dosing (82% vs. 67%, p<0.001). Mistimed doses occurred equally often among females receiving only two doses, as well as those receiving three doses. CONCLUSIONS Compliance with on-time HPV4 triplet dose completion was low at rural and urban core safety net health clinics, but did not differ by location.
Collapse
Affiliation(s)
- Kelly Jo Sandri
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Inge Verdenius
- Radboud University, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Mitchell J. Bartley
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Britney M. Else
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Christopher A. Paynter
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Beth E. Rosemergey
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - George D. Harris
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Sean M. Harper
- Hampshire College, Amherst, Massachusetts, United States of America
| | - R. Stephen Griffith
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Aaron J. Bonham
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Diane M. Harper
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| |
Collapse
|
42
|
Tota J, Ramana–Kumar A, El-Khatib Z, Franco E. The road ahead for cervical cancer prevention and control. Curr Oncol 2014; 21:e255-64. [PMID: 24764711 PMCID: PMC3997459 DOI: 10.3747/co.21.1720] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Since the early 1950s, Papanicolaou ("Pap") cytology screening has dramatically reduced cervical cancer mortality in most high-income settings. Currently, human papillomavirus (hpv) vaccination has the greatest potential to reduce the global burden of cervical cancer and precancerous lesions. However, as the prevalence of precancerous lesions declines, maintaining cytology as the primary screening test in settings with established programs might become less efficient. A reduction in test performance (sensitivity, specificity, and positive predictive value) would lead to an increase in unnecessary colposcopy referrals. Fortunately, hpv dna testing has emerged as a suitable candidate to replace cytology. Compared with the Pap test, hpv testing is less specific but much more sensitive in detecting high-grade precancerous lesions, less prone to human error, and more reproducible across settings. Linkage of hpv vaccination and screening registries could serve the added role of monitoring vaccine efficacy. As a triage test, cytology is expected to perform with sufficient accuracy because most hpv-positive smears would contain relevant abnormalities. This approach and others-for example, hpv testing followed by genotyping-are being evaluated in large population studies and have already been recommended in some settings. Other specific biomarkers that might perform well for screening and triage include hpv E6/E7 messenger rna testing, methylation of host or viral genes, and p16(INK4a) staining. Considering the rapid pace of major discoveries and the anticipated arrival of a nonavalent hpv vaccine (currently in phase iii trials), the evidence base in this field has become an elusive target and will continue to be an obstacle for policymakers.
Collapse
Affiliation(s)
- J.E. Tota
- Department of Oncology, McGill University, Montreal, QC
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| | | | - Z. El-Khatib
- Department of Oncology, McGill University, Montreal, QC
| | - E.L. Franco
- Department of Oncology, McGill University, Montreal, QC
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC
| |
Collapse
|
43
|
Harper DM, Verdenius I, Harris GD, Barnett AL, Rosemergey BE, Arey AM, Wall J, Malnar GJ. The influence of free quadrivalent human papillomavirus vaccine (HPV4) on the timely completion of the three dose series. Prev Med 2014; 61:20-5. [PMID: 24440159 DOI: 10.1016/j.ypmed.2014.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/24/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Economic incentives can positively influence social determinants to improve the health care of the uninsured and underserved populations. The aim of this study was to determine if free HPV4 vaccine would lead to on-time series completion in our safety net health care system in the US Midwest. METHODS A nested retrospective cohort study of females receiving HPV4 vaccine between 2006 and 2009 was conducted. Patient characteristics and payor source for each of the three HPV4 doses were abstracted from electronic records. Logistic regression was used to predict on-time completion rates. RESULTS The proportion of adolescent and adult females completing three on-time HPV4 doses was equal (21% (28/136) vs. 18% (66/358), respectively) from among the 494 females receiving 927 HPV4 doses in this study. No adolescent receiving free HPV4 vaccine completed three doses. Grant sponsorship of at least one HPV4 dose among adults did not predict three dose on-time completion (OR=1.56, 95%CI: 0.80, 3.06). Neither was adult grant sponsorship of HPV4 significant when analyzing exclusive payor sources vs. a combination of payor sources (OR=0.72, 95%CI: 0.10, 5.17). CONCLUSIONS Free HPV4 vaccine does not influence the on-time completion rates among adults.
Collapse
Affiliation(s)
- Diane M Harper
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA; Department of Obstetrics and Gynecology, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA; Department of Biomedical and Health Informatics, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | | | - George D Harris
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Angela L Barnett
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Beth E Rosemergey
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Anne M Arey
- Department of Community and Family Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| | - Gerard J Malnar
- Department of Obstetrics and Gynecology, University of Missouri - Kansas City School of Medicine, Kansas City, MO 64139, USA.
| |
Collapse
|
44
|
Weber SK, Schlagenhauf P. Childhood vaccination associated adverse events by sex: a literature review. Travel Med Infect Dis 2014; 12:459-80. [PMID: 24680600 DOI: 10.1016/j.tmaid.2014.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/23/2014] [Accepted: 01/28/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most approved medicines, including vaccines can be associated with adverse events. A vaccine adverse event is defined as any untoward medical occurrence which follows vaccination, but which does not necessarily have a causal relationship with the administration of the vaccine. METHODS The objective of this structured literature review is to analyse the adverse events reported with vaccinations usually done during childhood and adolescence: human papilloma virus vaccine, hepatitis B vaccine and measles-mumps-rubella vaccine. We evaluated the vaccine literature on children and adolescents by sex. We searched the Cochrane Database, Medline (Pubmed) and Embase using predefined terms. RESULTS Of the 417 publications retrieved from searches in the 3 databases, 89 papers (21%) were identified as potentially relevant to the review. On further scrutiny 41 of these satisfied the criteria for inclusion in the analysis. Serious adverse events related to vaccinations were rare. We found some possible sex related vaccine adverse events. Few trials however reported adverse events by age and sex and very few analyses evaluated the observed differences. CONCLUSIONS Despite earlier calls for sex-specific analyses of clinical studies, we found that vaccine trials were rarely reported and published by sex. Prospectively collated vaccine safety data in children and adolescents should be analysed by age and sex, so that clinical trial results can form an evidence base for vaccine practice recommendations.
Collapse
Affiliation(s)
- Sandra Köhli Weber
- School of Public Health at the Universities of Basel, Bern and Zürich, Hirschengraben 84, 8001 Zürich, Switzerland.
| | - Patricia Schlagenhauf
- Division of Epidemiology and Communicable Diseases, University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Hirschengraben 84, 8001 Zürich, Switzerland.
| |
Collapse
|
45
|
Gross G, Becker N, Brockmeyer NH, Esser S, Freitag U, Gebhardt M, Gissmann L, Hillemanns P, Grundhewer H, Ikenberg H, Jessen H, Kaufmann A, Klug S, Klußmann JP, Nast A, Pathirana D, Petry KU, Pfister H, Röllinghof U, Schneede P, Schneider A, Selka E, Singer S, Smola S, Sporbeck B, von Knebel Doeberitz M, Wutzler P. Vaccination against HPV-Associated Neoplasias: Recommendations from the Current S3 Guideline of the HPV Management Forum of the Paul-Ehrlich Society - AWMF Guidelines, Registry No. 082-002 (short version), valid until Dec. 31st, 2018. Geburtshilfe Frauenheilkd 2014; 74:233-241. [PMID: 27064858 DOI: 10.1055/s-0033-1360170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- G Gross
- Klinik und Poliklinik für Dermatologie und Venerologie, Universitätsmedizin, Universität Rostock, Rostock
| | - N Becker
- Deutsches Krebsforschungszentrum (DKFZ), Epidemiologie von Krebserkrankungen (C020), Heidelberg
| | - N H Brockmeyer
- Klinik für Dermatologie und Allergologie der Ruhr-Universität, Bochum
| | - S Esser
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Essen, Essen
| | | | | | - L Gissmann
- Deutsches Krebsforschungszentrum (DKFZ), FS Infektion und Krebs, Heidelberg
| | - P Hillemanns
- Medizinische Hochschule Hannover (MHH), Frauenklinik, Abt. I für Frauenheilkunde und Geburtshilfe, Hannover
| | - H Grundhewer
- Ausschuss Prävention des Berufsverbandes der Kinder- und Jugendärzte (BVKJ), Berlin
| | - H Ikenberg
- MVZ für Zytologie und Molekularbiologie (CytoMol), Frankfurt/M
| | - H Jessen
- Praxis Jessen + Kollegen, Berlin
| | - A Kaufmann
- Gynäkologische Tumorimmunologie, Gynäkologie mit Hochschulambulanz, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Klug
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - J P Klußmann
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Universität Gießen, Gießen
| | - A Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - D Pathirana
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - K U Petry
- Klinikum Wolfsburg, Abteilung Gynäkologische Onkologie, Wolfsburg
| | - H Pfister
- Institut für Virologie der Universität zu Köln
| | | | - P Schneede
- Klinikum Memmingen, Klinik für Urologie, Memmingen
| | - A Schneider
- Klinik und Poliklinik für Gynäkologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - E Selka
- VulvaKarzinom-SHG e. V., Wilhelmshaven
| | - S Singer
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Abt. Epidemiologie und Versorgungsforschung, Mainz
| | - S Smola
- Institut für Virologie, Institut für Infektionsmedizin, Universität des Saarlandes, Homburg/Saar
| | - B Sporbeck
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Allergologie und Venerologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin
| | - M von Knebel Doeberitz
- Abteilung für Molekulare Pathologie, Pathologisches Institut des Universitätsklinikum Heidelberg, Heidelberg
| | - P Wutzler
- Universitätsklinikum Jena (Friedrich-Schiller-Universität), Institut für Virologie und Antivirale Therapie, Beutenberg Campus, Jena
| |
Collapse
|
46
|
Lazcano-Ponce E, Stanley M, Muñoz N, Torres L, Cruz-Valdez A, Salmerón J, Rojas R, Herrero R, Hernández-Ávila M. Overcoming barriers to HPV vaccination: Non-inferiority of antibody response to human papillomavirus 16/18 vaccine in adolescents vaccinated with a two-dose vs. a three-dose schedule at 21 months. Vaccine 2014; 32:725-32. [DOI: 10.1016/j.vaccine.2013.11.059] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/06/2013] [Accepted: 11/15/2013] [Indexed: 12/28/2022]
|
47
|
Harper DM, Verdenius I, Ratnaraj F, Arey AM, Rosemergey B, Malnar GJ, Wall J. Quantifying clinical HPV4 dose inefficiencies in a safety net population. PLoS One 2013; 8:e77961. [PMID: 24223131 PMCID: PMC3819328 DOI: 10.1371/journal.pone.0077961] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 09/06/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE HPV4 is the most expensive vaccine requiring three appropriately timed doses to provide maximal efficacy against two oncogenic HPV types. The primary purpose of this study is to quantify the use of HPV4 vaccine in a safety net health care system in terms of its inefficiencies. METHODS A retrospective study of HPV4 dosing from 2006-2009, among females 10-26 years old who sought care in a safety net health care system was conducted to determine dose usage patterns among those at highest risk for cervical cancer. Dose descriptors abstracted from the electronic medical record (EMR) included timing and number in series as well as characteristics of the person to whom and visit at which the dose was given. Dose inefficiencies were separated into "less than three doses" and "mistimed doses" for analysis. RESULTS The majority (66%) of HPV4 doses administered were insufficient to induce the maximal immune response necessary for HPV infection prevention. Among on-time doses, 58% were singleton or doublet doses. Mistimed doses accounted for 19% of all doses administered with late intervals being more common than early intervals among those receiving more than one dose (9% vs. 4%, p<0.001). Third doses were mistimed twice as often as second doses (10% vs. 5%, p<0.001). Black women were more likely to have a mistimed second dose and Hispanic women more likely to have a mistimed third dose compared to white women (OR = 1.70 (95% CI: 1.11, 2.61 and 2.44 (1.19, 5.00), respectively). The HPV4-only visit type at which HPV4 was initiated was the most significant predictor of on-time doublet completion. CONCLUSIONS In a safety net health care system the large inefficiencies associated with HPV4 vaccination must be addressed in order to maximize our patient's cervical cancer prevention.
Collapse
Affiliation(s)
- Diane M. Harper
- Center of Excellence, Women’s Health, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Biomedical and Health Informatics, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- * E-mail:
| | - Inge Verdenius
- Department of Obstetrics and Gynecology, Radboud University, Nijmegen, The Netherlands
| | - Felicia Ratnaraj
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Anne M. Arey
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Beth Rosemergey
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| |
Collapse
|
48
|
Verdenius I, Harper DM, Harris GD, Griffith RS, Wall J, Hempstead LK, Malnar GJ, Bekkers RLM. Predictors of three dose on-time compliance with HPV4 vaccination in a disadvantaged, underserved, safety net population in the US Midwest. PLoS One 2013; 8:e71295. [PMID: 23951123 PMCID: PMC3738587 DOI: 10.1371/journal.pone.0071295] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/27/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND HPV4 is approved as a series of three timed doses expected to result in efficacy against specific HPV infections. Completion rates in the US are quite low at the same time the structure of health care delivery is changing. The aim of this study was to determine how the patient-, clinic- and systems-level characteristics facilitate or hinder the timely completion of three HPV4 doses in both adolescent and adult female populations in a high-risk safety net population. METHODS This is a retrospective study in which patient-, clinic- and systems-level data are abstracted from the electronic medical record (EMR) for all females 10-26 years of age receiving at least one dose of HPV4 between July 1, 2006 and October 1, 2009. RESULTS Adults were more likely to complete the three dose series if they had at least one health care visit in addition to their HPV4 visit, (aOR = 1.54 (95% CI:1.10, 2.15). Adults were less likely to complete the three dose series if they received their second HPV4 dose at an acute health care, preventive care or postpartum visits compared to an HPV4-only visit (aOR = 0.31 (95% CI: 0.13, 0.72), 0.12 (0.04, 0.35), 0.30 (0.14, 0.62), respectively). Hispanic adults were less likely than whites to complete the series (aOR = 0.24 (95% CI:0.10, 0.59). 39% of adolescents who completed two doses completed the series. CONCLUSIONS HPV4 is more likely to be effectively administered to adults in a safety net population if multiple health care needs can be met within the health care system.
Collapse
Affiliation(s)
| | - Diane M. Harper
- Center of Excellence, Women’s Health, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Departments of Biomedical and Health Informatics, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - George D. Harris
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - R. Stephen Griffith
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Laura K. Hempstead
- Department of Community and Family Medicine, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Ruud L. M. Bekkers
- Department of Obstetrics and Gynecology, Radboud University, Nijmegen, The Netherlands
| |
Collapse
|
49
|
Lindsey JC, Shah SK, Siberry GK, Jean-Philippe P, Levin MJ. Ethical tradeoffs in trial design: case study of an HPV vaccine trial in HIV-infected adolescent girls in lower income settings. Dev World Bioeth 2013; 13:95-104. [PMID: 23725055 PMCID: PMC3716837 DOI: 10.1111/dewb.12028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria.
Collapse
Affiliation(s)
- J C Lindsey
- Harvard School of Public Health – Center for Biostatistics in AIDS Research, 651 Huntington Avenue, Boston, MA 02115, USA.
| | | | | | | | | |
Collapse
|
50
|
Lamontagne DS, Thiem VD, Huong VM, Tang Y, Neuzil KM. Immunogenicity of quadrivalent HPV vaccine among girls 11 to 13 Years of age vaccinated using alternative dosing schedules: results 29 to 32 months after third dose. J Infect Dis 2013; 208:1325-34. [PMID: 23901077 DOI: 10.1093/infdis/jit363] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Immune response to quadrivalent human papillomavirus (HPV) vaccine delivered at 0, 2, and 6 months in young adolescent females plateaus around 24 months after immunization. Antibody levels >24 months postvaccination using extended dosing schedules is unknown. METHODS We conducted a follow-up immunogenicity study of adolescent girls in Vietnam who participated in a noninferiority trial to investigate whether immune responses using 3 alternative dosing schedules (0, 3, 9 months; 0, 6, 12 months; or 0, 12, 24 months) are noninferior to the standard schedule at >2 years after immunization. RESULTS Quadrivalent HPV vaccine immunogenicity delivered on 3 alternative dosing schedules was noninferior for types 6, 11, 16, and 18 at 32 months post-dose 3 compared to the standard schedule. Pre-dose 3 antibody levels for the 0, 12, 24 month schedule were similar to those measured 32-months post-dose 3. CONCLUSIONS We found similar antibody concentrations ≥29 months after 3 doses of HPV vaccine regardless of dose-timing, and extended schedules do not produce inferior immune responses. Our findings also suggested that 2 doses of HPV vaccine delivered at 0 and 12 months might afford similar protection. Evidence supporting dosing flexibility could be important for national HPV vaccination policies.
Collapse
|