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Khan I, Harshithkumar R, More A, Mukherjee A. Human Papilloma Virus: An Unraveled Enigma of Universal Burden of Malignancies. Pathogens 2023; 12:pathogens12040564. [PMID: 37111450 PMCID: PMC10146077 DOI: 10.3390/pathogens12040564] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
HPV, or Human Papilloma Virus, has been the primary causative agent of genital warts and cervical cancer worldwide. It is a sexually transmitted infection mainly affecting women of reproductive age group, also infecting men and high-risk group individuals globally, resulting in high mortality. In recent years, HPV has also been found to be the major culprit behind anogenital cancers in both gender and oropharyngeal and colorectal cancers. Few studies have reported the incidence of HPV in breast cancers as well. For a few decades, the burden of HPV-associated malignancies has been increasing at an alarming rate due to a lack of adequate awareness, famine vaccine coverage and hesitancy. The effectiveness of currently available vaccines has been limited to prophylactic efficacy and does not prevent malignancies associated with post-exposure persistent infection. This review focuses on the current burden of HPV-associated malignancies, their causes and strategies to combat the growing prevalence of the cancers. With the advent of new technologies associated with treatment pertaining to therapeutic interventions and employing effective vaccine coverage, the burden of this disease may be reduced in the population.
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Affiliation(s)
- Ishrat Khan
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, India
| | - R Harshithkumar
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, India
| | - Ashwini More
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, India
| | - Anupam Mukherjee
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, India
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Yousefi Z, Aria H, Ghaedrahmati F, Bakhtiari T, Azizi M, Bastan R, Hosseini R, Eskandari N. An Update on Human Papilloma Virus Vaccines: History, Types, Protection, and Efficacy. Front Immunol 2022; 12:805695. [PMID: 35154080 PMCID: PMC8828558 DOI: 10.3389/fimmu.2021.805695] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/31/2021] [Indexed: 12/18/2022] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted agent worldwide. Early prevention with HPV vaccination is a safe and effective method against this disease. HPV vaccines provided more protection against several oncogenic HPV strains. Three prophylactic HPV vaccines have been approved to target high-risk HPV types and protect against HPV-related disorders. These existing vaccines are based on the recombinant DNA technology and purified L1 protein that is assembled to form HPV empty shells. The prophylactic vaccines are highly immunogenic and can induce production of specific neutralizing antibodies. However, therapeutic vaccines are different from these prophylactic vaccines. They induced cell-mediated immunity against transformed cells, instead of neutralizing antibodies. The second generation of prophylactic HPV vaccines, made from alternative viral components using cost-effective production strategies, is undergoing clinical evaluation. The purpose of this review is to provide a complete and up-to-date review of the types of HPV vaccines and the efficiency of each of them for readers.
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Affiliation(s)
- Zahra Yousefi
- School of Allied Medical Sciences, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hamid Aria
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhoodeh Ghaedrahmati
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahereh Bakhtiari
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdieh Azizi
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Bastan
- Department of Immunopharmacology, Faculty of Medicine, Karaj University of Medical Sciences, Alborz, Iran
| | - Reza Hosseini
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Eskandari
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Marcellusi A, Mennini FS, Sciattella P, Favato G. Human papillomavirus in Italy: retrospective cohort analysis and preliminary vaccination effect from real-world data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1371-1379. [PMID: 34117988 PMCID: PMC8558199 DOI: 10.1007/s10198-021-01317-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/01/2021] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The objective of this study was to estimate the lifetime risk of hospitalization associated with all major human papillomavirus (HPV)-related diseases in Italy. Moreover, a preliminary vaccination effect was also performed. METHODS A retrospective, nonrandomized, observational study was developed based on patients hospitalized between 2006 and 2018 in Italy. All hospitalizations were identified through administrative archives, according to the International Classification of Diseases (ICD-9 CM). Information related to the hospital discharges of all accredited public and private hospitals, both for ordinary and day care regimes, was taken into account. We included hospitalizations related to resident patients presenting one of the ICD-9-CM codes as primary or secondary diagnosis: genital warts (GW); 'cervical intraepithelial neoplasia (CIN)' (067.32-067.33); 'condyloma acuminatum' (078.11); 'anal cancers' (AC) (154.2-154.8); oropharyngeal cancers (OC): 'oropharyngeal cancer'(146.0-146.9) and 'head, face and neck cancers' (171.0); genital cancers (GC): 'penis cancer' (187.1-187.9) and 'cervical cancer' (180.0-180.9). Data were stratified by birth year and divided into two groups: (a) cohort born before 1996 (not vaccinable) and (b) cohort born after 1997 (vaccinable-first cohort that could be vaccinated at the beginning of immunization schedule in girls since 2008 in Italy). Disease-specific hospitalization risks for both groups were estimated by sex, year and age. RESULTS Epidemiological data demonstrate that the peak hospitalization risk occurred at 24-26 years of age for GW (both male and female); 33-41 and 47-54 years for AC males and females, respectively; 53-59 and 52-58 years for OC males and females, respectively; and 54-60 and 39-46 years for GC males and females, respectively. Focusing on GW and GC, vaccinable females demonstrate a significant reduction in hospitalization risks (- 54% on average) compared to nonvaccinable females until 21 years of age (maximum follow-up available for girls born after 1997). Comparing the same birth cohort of males, no differences in hospitalization risk were found. CONCLUSIONS These results support the importance of primary prevention strategies in Italy and suggest that increased VCRs and time of observation (genital cancers for which vaccination is highly effective, have a latency of some decades) will provide useful information for decision-makers.
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Affiliation(s)
- A Marcellusi
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy.
- Institute for Leadership and Management in Health, Kingston University London, London, UK.
| | - F S Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
- Institute for Leadership and Management in Health, Kingston University London, London, UK
| | - P Sciattella
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome "Tor Vergata", Rome, Italy
| | - G Favato
- Institute for Leadership and Management in Health, Kingston University London, London, UK
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Impacts of Human Papillomavirus Immunization Programs on Rates of Anogenital Warts in British Columbia, Canada, 2000 to 2017. Sex Transm Dis 2021; 47:691-697. [PMID: 32649583 DOI: 10.1097/olq.0000000000001235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2008, British Columbia (BC) implemented a school-based quadrivalent human papillomavirus (HPV-4) immunization program for girls born in 1994 or later. In 2015, an expanded clinic-based program included men who report sex with men (MSM) born in 1989 or later. To evaluate the impacts of HPV-4 programs on anogenital warts (AGWs), diagnosis rates were measured among women who report sex with men (WSM), men who report sex with women (MSW), and MSM. METHODS Diagnoses of AGW were ascertained from 16 sexually transmitted infection clinics. Rates were calculated as new AGW diagnoses over person-years (py) at risk and stratified by age group, calendar period, and birth cohort. Adjusted relative rates (aRR) were estimated using multivariable Poisson regression. RESULTS There were 204,832 clinic visits by 85,158 individuals: 28,366 (33%) WSM, 35,688 (42%) MSW, and 14,534 (17%) MSM. After adjusting for age and period, AGW rates in the 1994-1996 birth cohort decreased by 56% overall (1.21 vs. 2.72 cases/100 py; aRR, 0.44; 95% confidence interval [CI], 0.34-0.59), 65% among WSM (0.97 vs. 2.77 cases/100 py; aRR, 0.35; 95% CI, 0.22-0.57), 58% among MSW (1.60 vs. 3.78 cases/100 py; aRR, 0.42; 95% CI, 0.28-0.65), and 41% among MSM (1.14 vs. 1.19 cases/100 py; aRR, 0.59; 95% CI, 0.38-0.91) versus the 1991-1993 birth cohort. CONCLUSIONS The HPV-4 programs had significant impacts on lowering AGW rates in BC. The greatest decrease was among WSM eligible for the school-based program, followed by birth cohorts of men who likely have sex with HPV-4 eligible women. The smallest decrease among MSM may reflect the later introduction of the clinic-based program.
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Infante V, Miyaji KT, Soarez PC, Sartori AMC. Systematic review and meta-analysis of HPV vaccination in women with systemic lupus erythematosus (SLE). Expert Rev Vaccines 2021; 20:309-318. [PMID: 33573404 DOI: 10.1080/14760584.2021.1889375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to access HPV vaccines' safety and immunogenicity in Systemic Lupus Erythematosus (SLE) women. METHODS The search was conducted in the most relevant databases. Meta-analyses to evaluate seroconversion rates for each HPV vaccine type and SLE flare rates after vaccination were performed. RESULTS We identified 3,467 articles; six papers referring to SLE population were included. Five articles that evaluated vaccine immunogenicity at 7th month after enrollment were included in the meta-analysis. Overall seroconversion rates among SLE participants were 89.3% (95%CI, 0.76-1.00) for HPV6; 92.4% (95%CI, 0.82-1.00) for HPV11; 96.4% (95%CI, 0.93-1.00) for HPV16; and 91.8% (95%CI, 0.85-1.00) for HPV18. Five studies were included in the qualitative analysis of vaccines safety. Pain at the injection site was the most common adverse event (AE). Just one study reported serious AE not related to the vaccine. Flare rate after HPV vaccination was 12,6% (95% CI, 0.04-0.21). CONCLUSION Few studies, small sample size, evaluated HPV vaccines in SLE women. Seroconversion rates in SLE women were like healthy women, but anti-HPV geometric mean titers (GMT) were slightly lower in SLE women. HPV vaccines were safe in this population.
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Affiliation(s)
- Vanessa Infante
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Karina Takesaki Miyaji
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Patricia Coelhode Soarez
- Departamento De Medicina Preventiva, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
| | - Ana Marli Christovam Sartori
- Departamento De Molestias Infecciosas E Parasitarias, Faculdade De Medicina Da Universidade De Sao Paulo, São Paulo, Brazil
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Cocchio S, Prandi GM, Furlan P, Bertoncello C, Fonzo M, Saia M, Baldovin T, Baldo V. Time-trend of hospitalizations for anogenital warts in Veneto region in the HPV vaccination era: a cross sectional study (2007-2018). BMC Infect Dis 2020; 20:857. [PMID: 33208109 PMCID: PMC7672898 DOI: 10.1186/s12879-020-05591-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) is a common sexually transmitted pathogen and the cause of several cancers and of anogenital warts. With this study, we estimated the trend of hospitalizations for anogenital warts (AGWs) in the Veneto region (Italy) from 2007 to 2018. METHODS The analysis included all the hospital discharge records of public and accredited private hospitals occurred in Veneto residents in the timespan 2007-2018. The ICD9-CM code 078.11 considered were those associated with condyloma acuminatum and those associated with surgical interventions for vulval/vaginal warts, penile warts anal warts. Annual total and sex- and age-specific hospitalization rates and trends were calculated and correlated with the different HPV vaccine coverage over the study period. RESULTS We observed an overall reduction of hospitalization rates for AGWs: from 15.0 hospitalizations every 100,000 Veneto residents in years 2007-08 to 10.9 hospitalizations every 100,000 Veneto residents in year 2017-18 (- 37.4%; p < 0.05). Reduction has been caused by a drop in hospitalizations in females - from a rate of 20.4/100,000 in 2007-2008 to a rate of 10.8/100,000 in 2017-18 (AAPC: -7.1; 95%CI: - 10.6;-3.4); while in males, we observed a slight - but not statistically significant - increase in hospitalization rates. CONCLUSION The marked decline in hospitalization rates for AGWs in Veneto Region is probably attributable to the high coverage rates of HPV vaccination programs implemented since 2008.
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Affiliation(s)
- S Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - G M Prandi
- Department for Woman and Child Health, University of Padua, Padua, Italy
| | - P Furlan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - C Bertoncello
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Fonzo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Saia
- "Azienda Zero" of Veneto region, Padua, Italy
| | - T Baldovin
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - V Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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Louvanto K, Eriksson T, Gray P, Apter D, Baussano I, Bly A, Harjula K, Heikkilä K, Hokkanen M, Huhtinen L, Ikonen M, Karttunen H, Nummela M, Söderlund-Strand A, Veivo U, Dillner J, Elfstöm M, Nieminen P, Lehtinen M. Baseline findings and safety of infrequent vs. frequent screening of human papillomavirus vaccinated women. Int J Cancer 2020; 147:440-447. [PMID: 31749143 DOI: 10.1002/ijc.32802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 11/07/2022]
Abstract
Less frequent cervical cancer screening in human papillomavirus (HPV) vaccinated birth cohorts could produce considerable savings without increasing cervical cancer incidence and loss of life-years. We report here the baseline findings and interim results of safety and accuracy of infrequent screening among HPV16/18 vaccinated females. The entire 1992-1994 birth-cohorts (30,139 females) were invited to a community-randomized HPV16/18-vaccination trial. A total of 9,482 female trial participants received HPV16/18-vaccination in 2007-2009 at age of 13-15. At age 22, 4,273 (45%) of these females consented to attend a randomized trial on frequent (ages 22/25/28; Arm 1: 2,073 females) vs. infrequent screening (age 28; Arm 2: 2,200 females) in 2014-2017. Females (1,329), who had got HPV16/18 vaccination at age 18 comprised the safety Arm 3. Baseline prevalence and incidence of HPV16/18 and other high-risk HPV types were: 0.5% (53/1,000 follow-up years, 104 ) and 25% (2,530/104 ) in the frequently screened Arm 1; 0.2% (23/104 ) and 24% (2,413/104 ) in the infrequently screened Arm 2; and 3.1% (304/104 ) and 23% (2,284/104 ) in the safety Arm 3. Corresponding prevalence of HSIL/ASC-H and of any abnormal cytological findings were: 0.3 and 4.2% (Arm 1), 0.4 and 5.3% (Arm 2) and 0.3 and 4.7% (Arm 3). Equally rare HSIL/CIN3 findings in the infrequently screened safety Arm A3 (0.4%) and in the frequently screened Arm 1 (0.4%) indicate no safety concerns on infrequent screening despite the up to 10 times higher HPV16/18 baseline prevalence and incidence in the former.
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Affiliation(s)
- Karolina Louvanto
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
| | - Tiina Eriksson
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Penelope Gray
- Department of Health Sciences, Tampere University, Tampere, Finland
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Dan Apter
- VL-Medi Clinical Research Center, Family Federation Finland, Helsinki, Finland
| | - Iacopo Baussano
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Anne Bly
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Katja Harjula
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Kaisa Heikkilä
- Department of Obstetrics and Gynecology, Turku University Hospital, University of Turku, Turku, Finland
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Mari Hokkanen
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Leila Huhtinen
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Marja Ikonen
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Heidi Karttunen
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Mervi Nummela
- Department of Health Sciences, Tampere University, Tampere, Finland
| | | | - Ulla Veivo
- Department of Health Sciences, Tampere University, Tampere, Finland
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Miriam Elfstöm
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Pekka Nieminen
- Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland
| | - Matti Lehtinen
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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Orumaa M, Kjaer SK, Dehlendorff C, Munk C, Olsen AO, Hansen BT, Campbell S, Nygård M. The impact of HPV multi-cohort vaccination: Real-world evidence of faster control of HPV-related morbidity. Vaccine 2020; 38:1345-1351. [PMID: 31917039 DOI: 10.1016/j.vaccine.2019.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2009, both Norway and Denmark initiated routine quadrivalent human papillomavirus vaccination (qHPV) for 12-year-old girls; however, Denmark also introduced free-of-charge multi-cohort vaccination for older age groups in 2008. We aim to describe trends in genital warts (GWs) incidence rates (IRs) among men and women and qHPV vaccine coverage among women in Norway and Denmark in 2006-2015. METHODS We linked multiple national health registries in Norway and Denmark via national personal identifiers to access data on GWs incidence and qHPV vaccination among women and men aged 12-35 years residing in Norway and Denmark in 2006-2015. We calculated age-specific and age-standardized GWs IRs, GWs IR trends before (2006-2009) and after (2009-2015) the implementation of qHPV vaccination, and qHPV vaccine coverage among women. RESULTS In Norway and Denmark together, there were more than 200,000 cases of incident GWs and over 710,000 girls got at least one dose of qHPV vaccine during the study period. The total qHPV coverage in Norway and Denmark in 2015 was among women aged 12-35 years 24% and 70%, respectively. GWs IRs in Norway and Denmark decreased annually in 2009-2015 among women by 4.8% (95% confidence interval: 4.3 to 5.3) and 18.0% (95%CI: 17.5 to 18.6), respectively, and among men 1.9% (95%CI: 1.4 to 2.4) and 10.7% (95%CI: 10.3 to 11.2), respectively. In Denmark, GWs IRs decreased rapidly among both sexes and all age groups after qHPV vaccination, while Norway showed only a modest decrease. CONCLUSION Rapid decline in HPV-related morbidity is feasible with high coverage of multi-cohort vaccination. However, the decision to vaccinate a single cohort of 12-years-old girls only will postpone HPV-related disease control by at least a decade. Thus countries planning HPV vaccination programs should also initiate multi-cohort vaccination for faster disease control.
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Affiliation(s)
- Madleen Orumaa
- HPV-related Epidemiological Research Unit, Department of Research, Cancer Registry of Norway, Oslo University Hospital, P.O. Box 5313 Majorstuen, N-0304 Oslo, Norway
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Christian Dehlendorff
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Anne Olaug Olsen
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway
| | - Bo T Hansen
- HPV-related Epidemiological Research Unit, Department of Research, Cancer Registry of Norway, Oslo University Hospital, P.O. Box 5313 Majorstuen, N-0304 Oslo, Norway
| | - Suzanne Campbell
- HPV-related Epidemiological Research Unit, Department of Research, Cancer Registry of Norway, Oslo University Hospital, P.O. Box 5313 Majorstuen, N-0304 Oslo, Norway
| | - Mari Nygård
- HPV-related Epidemiological Research Unit, Department of Research, Cancer Registry of Norway, Oslo University Hospital, P.O. Box 5313 Majorstuen, N-0304 Oslo, Norway.
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Subasinghe AK, Wark JD, Phillips S, Cornall A, Brotherton JML, Garland SM. Quadrivalent human papillomavirus vaccination successfully reduces the prevalence of vaccine-targeted genotypes in a young, vaccine-eligible-age sample of Australian females. Sex Health 2020; 17:510-516. [PMID: 33341122 DOI: 10.1071/sh20033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022]
Abstract
Background The prevalence of genital tract vaccine-type human papillomavirus (HPV) is on the decline due to high vaccine uptake through the national HPV immunisation program in Australia. The aim of this study was to investigate HPV vaccine coverage and factors associated with HPV in a vaccine-eligible sample of young Australian females. METHODS Females aged 16-25 years were recruited into the Young Female Health Initiative study, a young women's health study, via Facebook advertising from 2012 to 2017. Sexually active participants were asked to provide a self-collected vaginal swab for the detection of HPV DNA; positive samples were genotyped. Self-reported HPV vaccination status was confirmed by the National HPV Vaccination Program Register. Outcomes of the study were HPV acquisition and genotype, HPV vaccination status and factors associated with HPV. RESULTS Overall, 22.8% of samples (95% confidence interval (CI) 17.8-27.8%; n = 62/272) were positive for any HPV DNA, of which 19.1% (95% CI 14.4-23.8%; n = 52/272) were oncogenic types. HPV 16 was detected in three samples (1.1%; 95% CI -0.1%, 2.3%; two not HPV vaccinated and one vaccinated after sexual debut). Early sexual debut (<16 years) and multiple sexual partners were independently associated with an increased risk of any HPV. CONCLUSIONS In a community sample of vaccine-eligible-age females with a high vaccine uptake, the prevalence of vaccine-related HPV genotypes is extremely low. Early sexual debut and multiple sexual partners are positively associated with HPV, underscoring the importance of vaccination at the routinely recommended age of 12-13 years for best vaccine impact.
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Affiliation(s)
- Asvini K Subasinghe
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Present address: Department of General Practice, Monash University, 1/270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia; and Corresponding author.
| | - John D Wark
- The University of Melbourne Department of Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia; and Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia
| | - Samuel Phillips
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia
| | - Alyssa Cornall
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
| | - Julia M L Brotherton
- VCS Population Health, VCS Foundation, East Melbourne, Vic. 3002, Australia; and Melbourne School of Population and Global Health, The University of Melbourne, Vic. 3053, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia; and Murdoch Children's Research Institute, Infection and Immunity, Royal Women's Hospital, Flemington Road, Parkville, Vic. 3052, Australia; and Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Vic. 3052, Australia
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Kuhdari P, Previato S, Giordani M, Biavati P, Ferretti S, Gabutti G. The burden of HPV-related diseases in Italy, 2001-12. J Public Health (Oxf) 2019; 39:730-737. [PMID: 28334854 DOI: 10.1093/pubmed/fdx025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Indexed: 01/18/2023] Open
Abstract
Background Human papillomavirus (HPV) infection is the main cause of cervical cancer and plays a relevant role in the development of genital warts and of the cancer of penis and anus, head/neck, oropharynx and genitourinary system. The aim of this study is the evaluation of hospitalizations due to HPV-related pathologies in 2001-12 in Italy. Methods The national hospital discharge forms were provided by the Ministry of Health. The HPV-related hospitalizations were identified using specific diagnostic codes, accordingly to the ICD-9-CM coding system. The proportion of hospitalizations of potentially HPV-related pathologies, obtained from the literature, was evaluated as well as the hospitalization rates (hr) and their trend over time. Results Uterine cervical cancer and CIN III accounted for 40% of hospitalizations (hr: 15.6/100 000 and 17.6/100 000, respectively). Head/neck and oropharynx pathologies accounted for 24.5% of cases (hr: 16/100 000 and 3.9/100 000, in males and females, respectively), followed by genital warts (17.3% of hospitalizations; hr: 7.5/100 000 in males and 8.52/100 000 in females), anal (8.1% of hospitalizations), genitourinary (7.7%) and penis cancers (2.2%). Conclusions The study, even if limited to the evaluation of hospitalizations, points out how HPV-related pathologies continue to be a relevant public health issue in Italy with a high impact on population.
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Affiliation(s)
- P Kuhdari
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - S Previato
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - M Giordani
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - P Biavati
- Azienda USL Bologna, Registro Tumori Area Vasta Emilia Centrale, 40124 Bologna, Italy
| | - S Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy.,Azienda USL Ferrara, Registro Tumori Area Vasta Emilia Centrale, 44121 Ferrara, Italy
| | - G Gabutti
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, 44121 Ferrara, Italy.,Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
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11
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Sendagorta-Cudós E, Burgos-Cibrián J, Rodríguez-Iglesias M. Infecciones genitales por el virus del papiloma humano. Enferm Infecc Microbiol Clin 2019; 37:324-334. [DOI: 10.1016/j.eimc.2019.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/22/2022]
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12
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Early Evidence of the Effectiveness of the Human Papillomavirus Vaccination Program Against Anogenital Warts in Manitoba, Canada: A Registry Cohort Study. Sex Transm Dis 2019; 45:254-259. [PMID: 29465699 DOI: 10.1097/olq.0000000000000742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We assessed the effectiveness of the quadrivalent human papillomavirus vaccine (qHPV) vaccination program in Manitoba, Canada, in reducing incident anogenital warts (AGWs) and to what extent effectiveness depends on age at vaccination and number of doses. METHODS Female participants 9 years or older who received the qHPV in Manitoba between September 2006 and March 2013 (n = 31,464) through the publicly funded school-based program and a high-risk catch-up program were included. They were matched on age and area of residence to unvaccinated female participants. Information on incident AGWs was obtained from provincial administrative databases using validated algorithms. Using stratified Cox regression models, we estimate hazard ratios (HRs) for the association between qHPV and AGWs. RESULTS For female participants vaccinated at age 18 years or younger, receipt of qHPV was associated with a 40% reduction in AGW risk (HR, 0.6; 95% confidence interval [CI], 0.4-0.8). Further adjustment for socioeconomic and medical history did not alter this estimate. For women vaccinated at age 19 years or older, we saw an increase in AGW incidence, especially among those who were sexually active (HR, 2.8; 95% CI, 2.1-3.7). Among female participants vaccinated at age 18 years or younger, risk of AGWs was lowest among those who received 3 doses, corresponding to a vaccine effectiveness of 56% (95% CI, 30%-70%). For women vaccinated at older age, risk of AGWs remained increased regardless of the number of doses. CONCLUSIONS Women vaccinated at an older (≥19 years) age may be less protected against AGWs, particularly if sexually active before vaccine administration. Further efforts should be targeted at increasing vaccine uptake among preadolescents before the initiation of sexual activity.
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13
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Hasanzadeh M, Rejali M, Mehramiz M, Akbari M, Mousavi Seresht L, Yazdandoost Y, Farokhi S, Mahdian Z, Maleki F, Emamdadi-Aliabad Z, Jalilvand N, Khorrami S, Fadaei Z, Movahedi M, Hosseini Z, Razmi F, Takamoli T, Ferns GA, Avan A. The interaction of high and low-risk human papillomavirus genotypes increases the risk of developing genital warts: A population-based cohort study. J Cell Biochem 2019; 120:12870-12874. [PMID: 30868650 DOI: 10.1002/jcb.28557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 02/22/2019] [Indexed: 12/22/2022]
Abstract
Cervical cancer is among the most common type of cancers in women and is associated with human papillomavirus (HPV) infection. Genital warts are also reported to be linked with HPV infection types 11 and 6. In turn, clinical characteristics and morphological features of warts may be useful in the prediction of prognosis and in making treatment decisions. Thus, we have investigated the association of high and low-risk HPVs genotype with genital wart risk, as well as pathological and cytological information in cases recruited from a population-based cohort study of 1380 patients. Patients infected with HPV genotype 6 or 11 had an increased risk of having warts, with OR of 2.34 (95% CI: 0.955-5.737, P = 0.06). Also, this association was enhanced in the presence of high plus low-risk HPV for having genital wart (OR: 2.814; 95%: 1.208-6.55, P = 0.017) and cases having high-risk HPV (OR: 2.329; 95% CI: 1.029-5.269, P = 0.042). Moreover, we observed patients with genital warts having CIN2/3, indicating the importance of informing the physician to the patient to prevent more severe lesions. Our data demonstrated that patients with both low/high-risk HPV types had an increased risk of developing genital warts and persistent infection with HPV was a necessary precursor for the increase in cervical lesions.
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Affiliation(s)
- Malihe Hasanzadeh
- Department of Gynecology Oncology, Woman Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Rejali
- Department of Gynecology Oncology, Woman Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehraneh Mehramiz
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdieh Akbari
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Mousavi Seresht
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasaman Yazdandoost
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saba Farokhi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Mahdian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Faezeh Maleki
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Narjes Jalilvand
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shadi Khorrami
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Fadaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehraneh Movahedi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zeinab Hosseini
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Razmi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Toktame Takamoli
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, UK
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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14
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Bednarczyk RA. Addressing HPV vaccine myths: practical information for healthcare providers. Hum Vaccin Immunother 2019; 15:1628-1638. [PMID: 30676241 DOI: 10.1080/21645515.2019.1565267] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus (HPV) vaccine uptake consistently lags behind that of other adolescent vaccines. In 2017, uptake of a single HPV vaccine dose and HPV vaccine series completion was 66% and 49%, respectively, compared to uptake of tetanus, diphtheria, and acellular pertussis vaccine (89%) and quadrivalent meningococcal conjugate vaccine (85%). Reasons for not vaccinating adolescents again HPV are varied, and in many cases, are rooted in commonly spread myths and misperceptions about the vaccine. In this review, we address five key myths - HPV vaccination is not effective at preventing cancer; Pap smears are sufficient to prevent cervical cancer; HPV vaccination is not safe; HPV vaccination is not needed since most infections are naturally cleared by the immune system; 11-12 years of age is too young to vaccinate. For each myth, we summarize the scientific evidence refuting the myth and provide speaking prompts for healthcare professionals to communicate about HPV vaccination.
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Affiliation(s)
- Robert A Bednarczyk
- a Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta GA , USA.,b Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA.,c Cancer Prevention and Control Program, Winship Cancer Institute, Emory University , Atlanta GA , USA.,d Emory Vaccine Center, Emory University , Atlanta GA , USA
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15
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Steben M, Tan Thompson M, Rodier C, Mallette N, Racovitan V, DeAngelis F, Stutz M, Rampakakis E. A Review of the Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: 10 Years of Clinical Experience in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1635-1645. [DOI: 10.1016/j.jogc.2018.05.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
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16
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Perez S, Zimet GD, Tatar O, Stupiansky NW, Fisher WA, Rosberger Z. Human Papillomavirus Vaccines: Successes and Future Challenges. Drugs 2018; 78:1385-1396. [DOI: 10.1007/s40265-018-0975-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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17
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Delmonte S, Benardon S, Cariti C, Ribero S, Ramoni S, Cusini M. Anogenital warts treatment options: a practical approach. GIORN ITAL DERMAT V 2018; 155:261-268. [PMID: 30251804 DOI: 10.23736/s0392-0488.18.06125-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anogenital warts (AGWs) are an important issue for public health centers dealing with Sexually Transmitted Infections. They are epidemiologically relevant, with significant morbidity and an established effective treatment is lacking. In this article, we examine the epidemiological, diagnostic, and therapeutic aspect of the problem in order to give an up to date picture of the situation and a practical clue for the management of AGWs.
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Affiliation(s)
- Sergio Delmonte
- Clinic of Dermatology, Department of Medical Science, University of Turin, Turin, Italy -
| | - Susanna Benardon
- Department of Internal Medicine and Medical Specialties, State University of Milan, Milan, Italy.,Unit of Dermatology, Maggiore Polyclinic Hospital, Ca' Granda IRCCS and Foundation, Milan, Italy
| | - Caterina Cariti
- Clinic of Dermatology, Department of Medical Science, University of Turin, Turin, Italy
| | - Simone Ribero
- Clinic of Dermatology, Department of Medical Science, University of Turin, Turin, Italy
| | - Stefano Ramoni
- Unit of Dermatology, Maggiore Polyclinic Hospital, Ca' Granda IRCCS and Foundation, Milan, Italy
| | - Marco Cusini
- Unit of Dermatology, Maggiore Polyclinic Hospital, Ca' Granda IRCCS and Foundation, Milan, Italy
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18
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Doll MK, Quach C, Buckeridge DL. Evaluation of the Impact of a Rotavirus Vaccine Program on Pediatric Acute Gastroenteritis Hospitalizations: Estimating the Overall Effect Attributable to the Program as a Whole and as a Per-Unit Change in Rotavirus Vaccine Coverage. Am J Epidemiol 2018; 187:2029-2037. [PMID: 29757352 DOI: 10.1093/aje/kwy097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 04/25/2018] [Indexed: 12/29/2022] Open
Abstract
Estimation of the overall effect of a vaccine program is essential, but the effect is typically estimated for a whole program. We estimated the overall effect of the Quebec rotavirus vaccine program, launched in November 2011, and the effect for each 10% increase in rotavirus vaccine coverage on pediatric hospitalizations for all-cause acute gastroenteritis. We implemented negative binomial regressions adjusted for seasonality, long-term trends, and infection dynamics, to estimate the effect of the vaccine program as: 1) a dichotomous variable, representing program presence/absence, and linear term to account for changes in trend in the period after the program began; and 2) a continuous variable, representing rotavirus vaccine coverage. Using exposure 1, the vaccine program was associated with a 51.2% (95% confidence interval (CI): 28.5, 66.7) relative decline in adjusted weekly hospitalization rates for all-cause acute gastroenteritis as of December 28, 2014. Using exposure 2, a 10% increase in rotavirus ≥1-dose coverage was associated with a 7.1% (95% CI: 3.5, 10.5) relative decline in adjusted weekly rates, with maximum coverage of 87.0% associated with a 47.2% (95% CI: 26.9, 61.9) relative decline. Estimation of the overall effect attributable to a change in vaccine coverage might be a useful addition to standard measurement of the overall effect.
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Affiliation(s)
- Margaret K Doll
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Caroline Quach
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Quebec, Canada
- Infection Control and Prevention Unit, Division of Pediatric Infectious Diseases and Medical Microbiology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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19
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Tejada RA, Vargas KG, Benites-Zapata V, Mezones-Holguín E, Bolaños-Díaz R, Hernandez AV. Human papillomavirus vaccine efficacy in the prevention of anogenital warts: systematic review and meta-analysis. SALUD PUBLICA DE MEXICO 2018; 59:84-94. [PMID: 28423114 DOI: 10.21149/7824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/10/2016] [Indexed: 11/06/2022] Open
Abstract
Objective: To review evidence on the efficacy of HPV vaccines in the prevention of non-cancer lesions (anogenital warts [AGW], recurrent laryngeal papillomatosis and oral papillomatosis). Materials and methods: We conducted a systematic review of randomized trials. We performed random effect models and effects were reported as relative risks (RR) and their confidence intervals (95%CI) following both intention to treat (ITT) and per protocol (PP) analyses. Results: We included six studies (n=27 078). One study was rated as high risk of bias. One study could not be included in the meta-analysis because it provided combined results. We found that quadrivalent vaccine reduced the risk of AGW by 62% (RR: 0.38, 95%CI:0.32-0.45, I2:0%) in the ITT analysis and by 95% (RR: 0.05, 95%CI:0.01-0.25, I2:66%) in the PP analysis. Subgroup analyses of studies in women or with low-risk of bias provided similar results. Conclusion: HPV quadrivalent vaccine is efficacious in preventing AGW in men and women.
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Affiliation(s)
- Romina A Tejada
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Centro Nacional de Salud Pública, Instituto Nacional de Salud. Lima, Perú
| | - Kris G Vargas
- Department of Epidemiology, Erasmus MC. Rotterdam. Netherlands
| | - Vicente Benites-Zapata
- Centro de Investigación de Salud Pública, Instituto de Investigación, Facultad de Medicina Humana, Universidad de San Martín de Porres. Lima, Perú
| | - Edward Mezones-Holguín
- Intendencia de Investigación y Desarrollo, Superintendencia Nacional de Salud. Lima, Perú.,School of Medicine, Universidad Peruana de Ciencias Aplicadas. Lima, Perú
| | - Rafael Bolaños-Díaz
- Unidad de Análisis y Generación de Evidencias en Salud Pública, Centro Nacional de Salud Pública, Instituto Nacional de Salud. Lima, Perú.,Organización médica para el desarrollo de la salud. Lima, Perú
| | - Adrián V Hernandez
- School of Medicine, Universidad Peruana de Ciencias Aplicadas. Lima, Perú.,Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic. Ohio, USA
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20
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Kempe A, Allison MA, Daley MF. Can School-Located Vaccination Have a Major Impact on Human Papillomavirus Vaccination Rates in the United States? Acad Pediatr 2018; 18:S101-S105. [PMID: 29502627 DOI: 10.1016/j.acap.2017.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/15/2017] [Accepted: 08/19/2017] [Indexed: 10/17/2022]
Abstract
School-local vaccination (SLV) has been a highly effective method of increasing rates of human papillomavirus (HPV) vaccination in many countries internationally in which vaccines are purchased by national, regional, or local public health authorities and offered free of charge within schools. However, the effectiveness of SLV for increasing HPV vaccination rates in the United States is likely to be substantially limited due to a number of identified barriers, the most significant of which is with the need to bill for vaccines among adolescents not covered under the Vaccines for Children Program. HPV vaccination within school-based health centers (SBHCs) has been much more effective than SLV, but SBHCs exist in only 2% of schools in the United States. The opportunity gap between the United States and other countries will remain unless reimbursement issues related to HPV delivery in schools can be addressed in a sustainable manner or SBHCs become much more common.
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Affiliation(s)
- Allison Kempe
- ACCORDS (Adult and Child Consortium for Health Outcomes and Delivery Science), University of Colorado Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo.
| | - Mandy A Allison
- ACCORDS (Adult and Child Consortium for Health Outcomes and Delivery Science), University of Colorado Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver
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21
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Niccolai LM, Meek JI, Brackney M, Hadler JL, Sosa LE, Weinberger DM. Declines in Human Papillomavirus (HPV)-Associated High-Grade Cervical Lesions After Introduction of HPV Vaccines in Connecticut, United States, 2008-2015. Clin Infect Dis 2018; 65:884-889. [PMID: 28520854 DOI: 10.1093/cid/cix455] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/12/2017] [Indexed: 11/14/2022] Open
Abstract
Background Trends in human papillomavirus (HPV)-associated cervical lesions can provide an indication of vaccine impact. Our purpose was to measure trends in cervical lesions during 2008-2015 and to consider possible explanations including vaccination coverage, changes in screening for cervical cancer, and risk behaviors for acquiring HPV. Methods Connecticut (CT) implemented mandatory reporting of cervical intraepithelial neoplasia grades 2/3 and adenocarcinoma in situ (cervical intraepithelial neoplasia grade 2 or higher [CIN2+]) in 2008. Trends by age and birth cohort were modeled using negative binomial regression and change-point methods. To evaluate possible explanations for changes, these trends were compared to changes in HPV vaccination coverage, cervical cancer screening, an antecedent event to detection of a high-grade lesion, and changes in sexual behaviors and Chlamydia trachomatis, an infection with similar epidemiology to and shared risk factors for HPV. Results A significant decline in CIN2+ was first evident among women aged 21 years in 2010, followed by successive declines in women aged 22-26 years during 2011-2012. During 2008-2015, the rates of CIN2+ declined by 30%-74% among women aged 21-26 years, with greater declines observed in the younger women. Birth cohorts between 1985 and 1994 all experienced significant declines during the surveillance period, ranging from 25% to 82%. Ecological comparisons revealed substantial increases in HPV vaccination during this time period, and more modest reductions in cervical cancer screening and sexual risk behaviors. Conclusions The age and cohort patterns in our data suggest that declines in CIN2+ during 2008-2015 are more likely driven by HPV vaccination, introduced in 2006, than by changes in screening or risk behavior.
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Affiliation(s)
- Linda M Niccolai
- Connecticut Emerging Infections Program at Yale.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven
| | - James I Meek
- Connecticut Emerging Infections Program at Yale.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven
| | - Monica Brackney
- Connecticut Emerging Infections Program at Yale.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven
| | - James L Hadler
- Connecticut Emerging Infections Program at Yale.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven
| | - Lynn E Sosa
- Connecticut Department of Public Health, Hartford
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven
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22
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Ortiz AP, Ortiz-Ortiz KJ, Ríos M, Laborde J, Kulkarni A, Pillsbury M, Lauschke A, Monsanto HA, Marques-Goyco C. Modelling the effects of quadrivalent Human Papillomavirus (HPV) vaccination in Puerto Rico. PLoS One 2017; 12:e0184540. [PMID: 29190725 PMCID: PMC5708664 DOI: 10.1371/journal.pone.0184540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 08/25/2017] [Indexed: 11/18/2022] Open
Abstract
Background No study has estimated the potential impact of Human Papillomavirus (HPV) vaccination in Puerto Rico, a population with considerable burden of HPV-related morbidities. We evaluated the health and economic impacts of implementing a vaccination strategy for females and males in Puerto Rico, with the quadrivalent HPV (HPV4) vaccine, under different vaccination scenarios. Methods We adapted a mathematical model which estimates the direct and indirect health benefits and costs of HPV4 vaccination in a dynamic population. The model compared three vaccination scenarios against screening only (no-vaccination) for three doses of HPV4 vaccine among individuals aged 11–15 years in Puerto Rico: 1) 34% for females and 13% for males (34%F/13%M), 2) 50% for females and 40% for males (50%F/40%M), and 3) 80% for female and 64% for male (80%F/64%M). Data specific to Puerto Rico was used. When not available, values from the United States were used. Input data consisted of demographic, behavioral, epidemiological, screening, and economic parameters. Results The model predicted decreases in: 1) HPV infection prevalence for females and males, 2) cervical intraepithelial neoplasia and cervical cancer incidence for females, 3) genital warts incidence for females and males, and 4) cervical cancer deaths among females, when various vaccination program scenarios were considered. In addition, when the vaccination percentage was increased in every scenario, the reduction was greater and began earlier. The analysis also evidenced an incremental cost effectiveness ratio (ICER) of $1,964 per quality–adjusted life year gained for the 80%F/64%M uptake scenario. Conclusions HPV vaccine can prove its cost effectiveness and substantially reduce the burden and costs associated to various HPV-related conditions when targeted to the adequate population together with an organized HPV vaccination program.
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Affiliation(s)
- Ana Patricia Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- * E-mail:
| | - Karen J. Ortiz-Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Moraima Ríos
- Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - José Laborde
- Department of Economics, University of Puerto Rico, Rio Piedras Campus, San Juan, Puerto Rico
| | - Amit Kulkarni
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | | | - Andreas Lauschke
- Lauschke Consulting, New York, New York, United States of America
| | - Homero A. Monsanto
- Health Outcomes Research Regional Lead, Latin America Medical Affairs, Merck & Co, San Juan, Puerto Rico
| | - Cecile Marques-Goyco
- Health Outcomes Research Regional Lead, Latin America Medical Affairs, Merck & Co, San Juan, Puerto Rico
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23
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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.
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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
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Effectiveness of HPV vaccines against genital warts in women from Valencia, Spain. Vaccine 2017; 35:3342-3346. [PMID: 28499554 DOI: 10.1016/j.vaccine.2017.04.080] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/20/2017] [Accepted: 04/27/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the effectiveness of the HPV vaccines in preventing genital warts in young women. DESIGN Population-based study using health databases. SETTING Valencian Community (Spain). PARTICIPANTS All girls and women aged 14-19years who were registered in the Valencian Community between January 2009 and December 2014 (n=279,787). MAIN OUTCOME MEASURES Incident cases of genital warts were defined as the first activation of diagnosis code ICD-9-CM 078.11 (Condyloma acuminatum) in primary care and outpatient clinics during the study period. RESULTS There were 612 cases of genital warts. The overall incidence rate was 75.8/100,000 person-years (95% CrI 69.7-81.8). There was a decrease in genital warts when female candidates to be vaccinated with quadrivalent HPV vaccine reached the age of 18 (in 2012), compared to previous years. Incidence of genital warts in unvaccinated women and those who received the bivalent vaccine was higher than in girls and women who received the quadrivalent HPV vaccine. The effectiveness of a three-dose regimen of the quadrivalent HPV vaccine was 77% (95 CrI: 66-85%), whereas that of a single dose was 61% (95 CrI: 20-87%). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine. CONCLUSIONS Three doses of the quadrivalent HPV vaccine were effective against genital warts in our population. Moreover, with low vaccine coverage the incidence of genital warts decreased only in the vaccinated.
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Human Papillomavirus Types Involved in External Genital Warts in a Group of Argentinian Women in Buenos Aires. J Low Genit Tract Dis 2017; 20:365-6. [PMID: 27490078 DOI: 10.1097/lgt.0000000000000249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of the study was to understand which human papillomavirus (HPV) types are involved in external genital warts (GWs) in a group of Argentinian women in Buenos Aires. METHODS One hundred sixty consecutive women 15 to 45 years old with GWs were enrolled. All patients underwent confirmatory biopsy. In 150 of 160 patients, the diagnosis of GWs was confirmed by histology, DNA-HPV was investigated using polymerase chain reaction, and sequence analysis with generic primers MY09/11 was performed. RESULTS HPV 6 and/or 11 was detected in 93.3% patients (140/150). HPV 6 was by far the most common type (80%), followed by HPV 11 (12.7%). Coinfection with these 2 types occurred in 0.7%. HPV 16 was found in 2% and HPV 73 in 0.7%. CONCLUSION HPV 6 and/or 11 are present in 93.3% (95% confidence interval, 0.9-1.0) of external genital warts in a group of Argentinian women in Buenos Aires and, therefore, could be prevented with HPV vaccine (NCT 015998779).
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Suligoi B, Vittori G, Salfa MC, Timelli L, Corsini D, Fattorini G, Mariani L. Prevalence and incidence of external genital warts in a sample of Italian general female population. BMC Infect Dis 2017; 17:126. [PMID: 28166736 PMCID: PMC5294736 DOI: 10.1186/s12879-017-2202-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background The Human papillomavirus is the most common sexually transmitted virus worldwide. The objective of this study was to estimate: 1) the prevalence and the incidence of external genital warts (eGW) in a sample of women attending community outpatient clinics and 2) the total number of eGW cases in the Italian female population aged 15–64 years. Methods A prospective study was performed for a 12-month period between 2009 and 2010, among a sample of women attending community gynecological outpatient clinics located throughout Italy. Demographic data, for every woman aged 15–64 years, were collected. For women diagnosed with eGW, behavioral and clinical data were recorded. Prevalence of eGW was calculated as the proportion between the number of women with eGW and that of women visiting any of the participating gynecologists; incidence of eGW was calculated as the proportion between the number of women with a new diagnosis of eGW and that of women visiting any of the participating gynecologists. Standardized prevalence by age was used to estimate the number of eGW cases occurring in the Italian female population aged 15–64 years. Results In 2009–2010, 44 community gynecologists were included in the network. In one-year period, 16,410 women visited any of the participating gynecologists; 63 women were diagnosed with eGW, corresponding to a prevalence of 3.8 cases per 1,000 women per year (95%CI: 2.9-4.9). The incidence of eGW was 3.0 cases per 1,000 women per year (95%CI: 2.2-3.9). Women aged 15–24 years showed both the highest prevalence and incidence. Prevalence and incidence significantly decreased by increasing age group (p <0.001), and were higher in Southern Italy compared to Central-Northern Italy. The estimated number of women with eGW among women aged 15–64 years in Italy, in 2010, was approximately 69,000. Conclusions These data show a high prevalence and incidence of eGW among young women in Italy, stress the effectiveness of community clinical networks in investigating STI epidemiology among women from the general population, confirm the relevance of HPV vaccination programs among adolescents, and underscore the need of promoting safe sex, implementing early diagnosis, treatment and prevention of genital warts.
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Affiliation(s)
- Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, Italy.
| | | | - Maria Cristina Salfa
- Centro Operativo AIDS, Istituto Superiore di Sanità, Viale Regina Elena 299, Rome, Italy
| | | | | | - Giovanni Fattorini
- Associazione ginecologi territoriali (AGITE), Via G. Abamonti 1, Milan, Italy
| | - Luciano Mariani
- HPV-unit, Istituto Nazionale Tumori Regina Elena, Via Elio Chianesi 53, Rome, Italy
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Mariani L, Preti M, Cristoforoni P, Stigliano CM, Perino A. Overview of the benefits and potential issues of the nonavalent HPV vaccine. Int J Gynaecol Obstet 2017; 136:258-265. [PMID: 28087890 DOI: 10.1002/ijgo.12075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 10/17/2016] [Accepted: 12/01/2016] [Indexed: 12/22/2022]
Abstract
HPV-related diseases affect anogenital and oropharyngeal regions, heavily affecting the psychosexual dimension of both male and female individuals. HPV vaccination programs based on a bivalent or quadrivalent vaccine have opened broad perspectives for primary prevention. A nonavalent HPV vaccine (9vHPV), covering nine genotypes (HPV6, HPV11, HPV16, HPV18, HPV31, HPV33, HPV45, HPV52, and HPV58), might provide further improvement in terms of direct protection. In the present report, efficacy and safety data from 9vHPV vaccine development programs are examined. Efficacy data come from a pivotal trial, which was conducted among women aged 16-26 years randomly assigned to receive either the 9vHPV or the quadrivalent HPV (4vHPV) vaccine. The 9vHPV vaccine was shown to have potential benefits as compared with 4vHPV, increasing the overall estimated rate of prevention to 90% for cervical cancer and up to 80% for precancerous cervical lesions. For all other HPV-related pre-invasive and invasive lesions, 9vHPV showed potentially greater disease reduction, depending on the anatomic region examined. Thus, the 9vHPV vaccine shows clinical potential for the prevention of HPV-related diseases in both sexes. Future adoption of 9vHPV will depend on factors including market price, cost-effectiveness data, use of a two-dose schedule, and safety and efficacy monitoring in real-life programs.
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Affiliation(s)
- Luciano Mariani
- Regina Elena National Cancer Institute, HPV-Unit, Gynecologic Oncology, Rome, Italy
| | - Mario Preti
- Department of Obstetrics and Gynecology, University of Torino, Turin, Italy
| | | | - Carlo M Stigliano
- Unità Ospedaliera Complessa Ginecologia Preventiva, Azienda Sanitaria Provinciale di Cosenza, Castrovillari, Italy
| | - Antonio Perino
- Obstetrics and Gynecology, Ospedali Riuniti Villa Sofia Cervello, University of Palermo, Palermo, Italy
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Guerra FM, Rosella LC, Dunn S, Wilson SE, Chen C, Deeks SL. Early impact of Ontario's human papillomavirus (HPV) vaccination program on anogenital warts (AGWs): A population-based assessment. Vaccine 2016; 34:4678-4683. [PMID: 27527815 DOI: 10.1016/j.vaccine.2016.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION This study aimed to evaluate the early population impact of Ontario's school-based human papillomavirus (HPV) vaccination program, implemented in September 2007 for grade 8 females, by comparing anogenital wart (AGW) health care utilization before and after vaccine program implementation, in program-eligible and program-ineligible cohorts, focusing on 15-26year olds. METHODS Using a retrospective longitudinal population-based study design, health administrative data were used to identify incident AGWs and total health service utilization (HSU) for AGWs for Ontario residents 15years and older between April 1 2004 and March 31 2014. The study period was divided into two eras: the pre-vaccine program era and the vaccine program era. Negative binomial models were generated to analyze trends across time by age group and sex. We adjusted female rates for routine Papanicolaou (Pap) testing to address spillover effects of Pap smear policy changes on AGW diagnosis. RESULTS Between fiscal years 2004 and 2013, AGW incidence decreased 2.6% on average per year in 15-17year old females, and total HSU for AGWs decreased an average of 4.8% and 2.2% per year in 15-17 and 18-20year old females. Comparing the vaccine era to the pre-vaccine era, AGW incidence decreased 6.5% in 18-20year old females, and AGW HSU decreased 13.8%, 11.1%, and 10.0% in 15-17, 18-20, and 21-23year old females respectively. In contrast, male AGW incidence rates increased an average of 4.1%, 2.8%, and 0.9% per year in 15-17, 21-23, and 24-26year old males respectively. AGW incidence rates increased 12.2% in 15-17year old males from the pre-vaccine to vaccine era. CONCLUSION The decline in AGW incidence and HSU in program-eligible females suggests the school-based HPV vaccination program has had an early population impact in Ontario. The increasing AGW incidence in males suggests no early evidence of herd effects in males.
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Affiliation(s)
- Fiona M Guerra
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada.
| | - Laura C Rosella
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G106, Toronto, ON M4N 3M5, Canada.
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada; Women's College Hospital and Women's College Research Institute, 790 Bay St, Toronto, ON M5G 1N8, Canada.
| | - Sarah E Wilson
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G106, Toronto, ON M4N 3M5, Canada.
| | - Cynthia Chen
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada.
| | - Shelley L Deeks
- Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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Reinholz M, Hermans C, Ruzicka T, Dietrich A. [Anogenital diseases caused by human papillomavirus - A modern pandemia]. MMW Fortschr Med 2016; 158:64-6. [PMID: 26979226 DOI: 10.1007/s15006-016-7946-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
MESH Headings
- Anus Neoplasms/diagnosis
- Anus Neoplasms/epidemiology
- Anus Neoplasms/therapy
- Cross-Sectional Studies
- Female
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/epidemiology
- Genital Neoplasms, Female/therapy
- Genital Neoplasms, Male/diagnosis
- Genital Neoplasms, Male/epidemiology
- Genital Neoplasms, Male/therapy
- Germany
- Humans
- Male
- Pandemics
- Papillomavirus Infections/diagnosis
- Papillomavirus Infections/epidemiology
- Papillomavirus Infections/therapy
- Papillomavirus Infections/transmission
- Risk Factors
- Sexually Transmitted Diseases, Viral/diagnosis
- Sexually Transmitted Diseases, Viral/epidemiology
- Sexually Transmitted Diseases, Viral/therapy
- Sexually Transmitted Diseases, Viral/transmission
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Affiliation(s)
- Markus Reinholz
- Klinik und Poliklinik für Dermatologie und Allergologie Ludwig-Maximilians-Universität München Frauenlobstr.9-11, D-80337 München.
| | - Cecilia Hermans
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Ratzeburger Allee 160, D-23538, Lübeck, Deutschland
| | - Thomas Ruzicka
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Ratzeburger Allee 160, D-23538, Lübeck, Deutschland
| | - Andreas Dietrich
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München, Ratzeburger Allee 160, D-23538, Lübeck, Deutschland
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Human papillomavirus epidemiology and vaccine recommendations: selected review of the recent literature. Curr Opin Pediatr 2016; 28:400-6. [PMID: 27093357 DOI: 10.1097/mop.0000000000000354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW This article provides a clinically relevant review and analysis of the latest research and recommendations regarding human papillomavirus (HPV) vaccine. RECENT FINDINGS Although studies have found that bivalent and quadrivalent HPV vaccines are well tolerated and effective, high-risk HPV types not included in these vaccines are responsible for a significant burden of disease worldwide. Clinical trials have found that the recently licensed 9-valent vaccine, which includes five additional high-risk HPV types, is well tolerated and efficacious. This vaccine was added to the Advisory Committee on Immunization Practices HPV vaccination recommendations in 2015. A two-dose series in girls and boys 9-14 years old with a 6- or 12-month interval between doses has been shown to result in antibody titers noninferior to those measured after the three-dose series in women 16-26 years old. The Food and Drug Administration is considering these data. SUMMARY Recent publications highlight the safety and effectiveness of HPV vaccines, the licensure of the 9-valent HPV vaccine, and the revision of HPV vaccine recommendations.
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Garland SM, Kjaer SK, Muñoz N, Block SL, Brown DR, DiNubile MJ, Lindsay BR, Kuter BJ, Perez G, Dominiak-Felden G, Saah AJ, Drury R, Das R, Velicer C. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clin Infect Dis 2016; 63:519-27. [PMID: 27230391 PMCID: PMC4967609 DOI: 10.1093/cid/ciw354] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022] Open
Abstract
This systematic review assessed the global impact and effectiveness of quadrivalent human papillomavirus (HPV) vaccination on HPV infection and disease in real-world settings over a decade of use. Substantial reductions in HPV 6/11/16/18 infection, anogenital warts, and cervical lesions have been achieved. Prophylactic human papillomavirus (HPV) vaccination programs constitute major public health initiatives worldwide. We assessed the global effect of quadrivalent HPV (4vHPV) vaccination on HPV infection and disease. PubMed and Embase were systematically searched for peer-reviewed articles from January 2007 through February 2016 to identify observational studies reporting the impact or effectiveness of 4vHPV vaccination on infection, anogenital warts, and cervical cancer or precancerous lesions. Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infection, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The full public health potential of HPV vaccination is not yet realized. HPV-related disease remains a significant source of morbidity and mortality in developing and developed nations, underscoring the need for HPV vaccination programs with high population coverage.
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Affiliation(s)
- Suzanne M Garland
- Royal Women's Hospital, University of Melbourne, Murdoch Childrens Research Institute, Victoria, Australia
| | - Susanne K Kjaer
- Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen, Denmark
| | - Nubia Muñoz
- Colombian National Institute of Cancer, Bogota
| | - Stan L Block
- Kentucky Pediatric and Adult Research, Bardstown
| | | | | | | | | | - Gonzalo Perez
- Merck & Co, Inc, Kenilworth, New Jersey Universidad del Rosario, Bogota, Colombia
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Boiron L, Joura E, Largeron N, Prager B, Uhart M. Estimating the cost-effectiveness profile of a universal vaccination programme with a nine-valent HPV vaccine in Austria. BMC Infect Dis 2016; 16:153. [PMID: 27084683 PMCID: PMC4833954 DOI: 10.1186/s12879-016-1483-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 03/25/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HPV is a major cancer-causing factor in both sexes in the cervix, vulva, vagina, anus, penis, oropharynx as well as the causal factor in other diseases such as genital warts and recurrent respiratory papillomatis. In the context of the arrival of a nonavalent HPV vaccine (6/11/16/18/31/33/45/52/58), this analysis aims to estimate the public health impact and the incremental cost-effectiveness of a universal (girls and boys) vaccination program with a nonavalent HPV vaccine as compared to the current universal vaccination program with a quadrivalent HPV vaccine (6/11/16/18), in Austria. METHOD A dynamic transmission model including a wide range of health and cost outcomes related to cervical, anal, vulvar, vaginal diseases and genital warts was calibrated to Austrian epidemiological data. The clinical impact due to the 5 new types was included for cervical and anal diseases outcomes only. In the base case, a two-dose schedule, lifelong vaccine type-specific protection and a vaccination coverage rate of 60% and 40% for girls and boys respectively for the 9-year old cohorts were assumed. A cost-effectiveness threshold of €30,000/QALY-gained was considered. RESULTS Universal vaccination with the nonavalent vaccine was shown to reduce the incidence of HPV16/18/31/33/45/52/58 -related cervical cancer by 92%, the related CIN2/3 cases by 96% and anal cancer by 83% and 76% respectively in females and males after 100 years, relative to 75%, 76%, 80% and 74% with the quadrivalent vaccine, respectively. Furthermore, the nonavalent vaccine was projected to prevent an additional 14,893 cases of CIN2/3 and 2544 cases of cervical cancer, over 100 years. Depending on the vaccine price, the strategy was shown to be from cost-saving to cost-effective. CONCLUSION The present evaluation showed that vaccinating 60% of girls and 40% of boys aged 9 in Austria with a 9-valent vaccine will substantially reduce the incidence of cervical cancer, CIN and anal cancer compared to the existing strategy. The vaccination strategies performed with the 9-valent vaccine in the current study were all found to be cost-effective compared to the current quadrivalent vaccination strategy by considering a cost-effectiveness threshold of 30,000€/QALY gained.
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Affiliation(s)
- L. Boiron
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
| | - E. Joura
- />Department of Gynecology and Obstetrics, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - N. Largeron
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
| | - B. Prager
- />Sanofi Pasteur MSD, Campus 21, Europarin F11/402, Brunn am Gebirge, A-2345 Austria
| | - M. Uhart
- />Sanofi Pasteur MSD, 162 avenue Jean Jaurès CS 50712 69367, Lyon, Cedex 07 France
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Hammer A, Rositch A, Qeadan F, Gravitt PE, Blaakaer J. Age-specific prevalence of HPV16/18 genotypes in cervical cancer: A systematic review and meta-analysis. Int J Cancer 2016; 138:2795-803. [DOI: 10.1002/ijc.29959] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Anne Hammer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Anne Rositch
- Johns Hopkins Bloomberg School of Public Health; MD
| | - Fares Qeadan
- Department of Internal Medicine; University of New Mexico Health Sciences Center; NM
| | - Patti E Gravitt
- Department of Pathology; University of New Mexico Health Sciences Center; NM
| | - Jan Blaakaer
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
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Bridges CB, Hurley LP, Williams WW, Ramakrishnan A, Dean AK, Groom AV. Meeting the Challenges of Immunizing Adults. Am J Prev Med 2015; 49:S455-64. [PMID: 26382294 DOI: 10.1016/j.amepre.2015.08.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 12/31/2022]
Abstract
The overall burden of illness from diseases for which vaccines are available disproportionately falls on adults. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccine recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Vaccine use among U.S. adults is low. Although receipt of a provider (physician or other vaccinating healthcare provider) recommendation is a key predictor of vaccination, more often consumers report not receiving vaccine recommendations at healthcare provider visits. Although providers support the benefits of vaccination, they also report several barriers to vaccinating adults, including the cost of providing vaccination services, inadequate or inconsistent payment for vaccines and vaccine administration, and acute medical care taking precedence over preventive services. Despite these challenges, a number of strategies have been demonstrated to substantially improve adult vaccine coverage, including patient and provider reminders and standing orders for vaccination. Providers are encouraged to incorporate routine assessment of their adult patients' vaccination needs during all clinical encounters to ensure patients receive recommendations for needed vaccines and are either offered needed vaccines or referred for vaccination.
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Affiliation(s)
- Carolyn B Bridges
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
| | - Laura P Hurley
- Department of General Internal Medicine, Denver Health, Denver, Colorado; Department of Medicine, University of Colorado-Denver, Aurora, Colorado
| | - Walter W Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Aparna Ramakrishnan
- Northrup Grumman contractor working with Health Communications Science Office, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Anna K Dean
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Amy V Groom
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
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Hartwig S, Baldauf JJ, Dominiak-Felden G, Simondon F, Alemany L, de Sanjosé S, Castellsagué X. Estimation of the epidemiological burden of HPV-related anogenital cancers, precancerous lesions, and genital warts in women and men in Europe: Potential additional benefit of a nine-valent second generation HPV vaccine compared to first generation HPV vaccines. PAPILLOMAVIRUS RESEARCH 2015. [PMCID: PMC5886848 DOI: 10.1016/j.pvr.2015.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction A second generation HPV vaccine has been developed for the prevention of anogenital cancers and precancerous lesions of the cervix, vulva, vagina, anus and of genital warts due to nine HPV types. We estimated the annual burden of these diseases attributable to the nine HPV types compared to HPV types from first generation vaccines in women and men in Europe. Material and methods Incidence rates from the IARC database, cancer registries, the literature and Eurostat population data were used. The burden attributable to the HPV types targeted by both vaccines was estimated by applying the relative contribution of the respective HPV types from epidemiological studies. Results In 2013, the number of new anogenital HPV-attributable cancers was 44,480 with 39,494 of these cases related to second vs. 33,285 to first generation vaccine types. Among the 284,373 to 541,621 new HPV-attributable anogenital precancerous lesions 235,364–448,423 and 135,025–256,830 were estimated to be related to second and first generation vaccine types, respectively. The annual number of new genital warts was 753,608–935,318, with 90% related to HPV6/11. Conclusions These data demonstrate how the large public health impact that was achieved by the first generation HPV vaccines could be further increased by second generation vaccines.
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El-Zein M, Richardson L, Franco EL. Cervical cancer screening of HPV vaccinated populations: Cytology, molecular testing, both or none. J Clin Virol 2015; 76 Suppl 1:S62-S68. [PMID: 26631958 DOI: 10.1016/j.jcv.2015.11.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/12/2015] [Accepted: 11/15/2015] [Indexed: 12/13/2022]
Abstract
Cervical cancer control includes primary prevention through vaccination to prevent human papillomavirus (HPV) infection and secondary prevention through screening to detect and treat cervical precancerous lesions. This review summarizes the evidence for the population impact of vaccines against oncogenic HPV types in reducing the prevalence of cervical precancerous lesions. We examine the gradual shift in screening technology from cervical cytology alone to cytology and HPV cotesting, and finally to the recognition that HPV testing can serve alone as the new screening paradigm, particularly in the initial post-vaccination era. We should expect an impact on screening performance and practices, as cohorts of HPV-vaccinated girls and adolescents reach cervical cancer screening age. In preparation for changes in the screening paradigm for the vaccination era, we propose that policymaking on cervical cancer screening should mirror current practices with other cancers as benchmarks. Cervical precancerous lesions will become a very rare condition following the widespread implementation of HPV vaccines with broader coverage in the number of preventable oncogenic types. Irrespective of screening technology, the false positive results will far outnumber the true positive ones, a tipping point that will herald a new period when the harms from cervical cancer screening will outweigh its benefits. We present a conceptual framework to guide decision making when we reach this point within 25-30 years.
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Affiliation(s)
- Mariam El-Zein
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Lyndsay Richardson
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, Montreal, QC, Canada.
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Bridges CB, Hurley LP, Williams WW, Ramakrishnan A, Dean AK, Groom AV. Meeting the Challenges of Immunizing Adults. Vaccine 2015; 33 Suppl 4:D114-20. [DOI: 10.1016/j.vaccine.2015.09.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Petráš M, Adámková V. Impact of quadrivalent human papillomavirus vaccine in women at increased risk of genital warts burden: Population-based cross-sectional survey of Czech women aged 16 to 40 years. Vaccine 2015; 33:6264-7. [PMID: 26431981 DOI: 10.1016/j.vaccine.2015.09.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/08/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND To assess the impact of a quadrivalent human papillomavirus vaccine (4HPV) in women at increased risk of genital warts (GWs) acquisition. METHODS The study was conducted using a population-based cross-sectional survey of 19,199 women aged 16 to 40 years randomly chosen from the general population in the Czech Republic between January 2013 and March 2014. A total of 1086 women reported having received the 4HPV vaccine. The vaccine's effectiveness was estimated not only in the general population of women but also in those at increased risk due to having a sexual partner with GWs or prior GWs history. RESULTS The acquisition of GWs was dramatically reduced by 90.6% (80.1-95.6%) in immunised women at least one year after the completion of the 4HPV vaccination in comparison with unimmunised women. Recurrent GWs prevalences of 1.1% (95% CI, 0.0-5.9) and 10.9% (95% CI, 9.1-12.9) in immunised and unimmunised women with prior GWs history, respectively, resulted in a vaccine effectiveness of 89.0% (38.6-98.0%). The notably strong protective effect of 4HPV immunisation in women who had a sexual partner with GWs was demonstrated by a very low age-adjusted odds ratio of 0.02 (95% CI 0.01-0.10) in contrast to unimmunised women. CONCLUSIONS To lower the chance of genital warts acquisition in the general population and in populations at increased risk, only current 4HPV or incoming 9HPV vaccination should be recommended to provide effective protection.
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Affiliation(s)
- Marek Petráš
- Charles University in Prague-2nd Faculty of Medicine, V Úvalu 84, 150 06 Prague 5, Czech Republic.
| | - Věra Adámková
- Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic
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Abstract
BACKGROUND A quadrivalent human papillomavirus (HPV4) type 6/11/16/18 vaccine (GARDASIL/SILGARD®) has been licensed in many countries around the world for the prevention of cervical, vulvar, vaginal, and anal cancers and precancers, as well as external genital warts causally related to HPV types 6/11/16/18. Across 7 phase 3 clinical trials involving more than 29,000 males and females ages 9-45 years, vaccination was generally well tolerated. Because of its expected public health benefit in reducing cervical cancer and other HPV-related diseases, the vaccine has been implemented in the national vaccination programs of several countries, with over 178 million doses distributed worldwide. METHODS Extensive efforts to assess the safety of the vaccine in routine practice have been conducted over the past 9 years since licensure, including more than 15 studies in more than 1 million preadolescents, adolescents and adults from various countries. Most have been performed in the general population although there have been some in special populations (pregnant women, HIV-infected individuals and those with systemic lupus erythematosus). RESULTS We present a summary of the published, postlicensure safety data from active and passive surveillance. Only syncope, and possibly skin infections were associated with vaccination in the postlicensure setting. Serious adverse events, such as adverse pregnancy outcomes, autoimmune diseases (including Guillain-Barre Syndrome and multiple sclerosis), anaphylaxis, venous thromboembolism and stroke, were extensively studied, and no increase in the incidence of these events was found compared with background rates. CONCLUSIONS These results, along with the safety data from the prelicensure clinical trials, confirm that the HPV4 vaccine has a favorable safety profile. Key policy, medical and regulatory organizations around the world have independently reviewed these data and continue to recommend routine HPV vaccination.
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Audisio RA, Icardi G, Isidori AM, Liverani CA, Lombardi A, Mariani L, Mennini FS, Mitchell DA, Peracino A, Pecorelli S, Rezza G, Signorelli C, Rosati GV, Zuccotti GV. Public health value of universal HPV vaccination. Crit Rev Oncol Hematol 2015; 97:157-67. [PMID: 26346895 DOI: 10.1016/j.critrevonc.2015.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The story of Human Papillomavirus vaccination demands reflection not only for its public health impact on the prophylactic management of HPV disease, but also for its relevant economic and social outcomes. Greater than ever data confirm the efficacy and support the urge for effective vaccination plans for both genders before sexual debut. METHODS A review of previous experience in gender-restricted vaccination programs has demonstrated a lower effectiveness. Limiting vaccination to women might increase the psychological burden on women by confirming a perceived inequality between genders; and even if all women were immunized, the HPV chain of transmission would still be maintained through men. RESULTS The cost-effectiveness of including boys into HPV vaccination programs should be re-assessed in view of the progressive drop of the economic burden of HPV-related diseases in men and women due to universal vaccination. The cost of the remarkable increase in anal and oropharyngeal HPV driven cancers in both sexes has been grossly underestimated or ignored. CONCLUSIONS Steps must be taken by relevant bodies to achieve the target of universal vaccination. The analysis of HPV vaccination's clinical effectiveness vs. economic efficacy are supportive of the economic sustainability of vaccination programs both in women and men. In Europe, these achievements demand urgent attention to the social equity for both genders in healthcare. There is sufficient ethical, scientific, strategic and economic evidence to urge the European Community to develop and implement a coordinated and comprehensive strategy aimed at both genders and geographically balanced, to eradicate cervical cancer and other diseases caused by HPV in Europe. Policymakers must take into consideration effective vaccination programs in the prevention of cancers.
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Affiliation(s)
| | - Giancarlo Icardi
- Department of Health Sciences, Hygiene Unit, IRCCS AOU San Martino, IST University of Genoa, Genoa, Italy.
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| | - Carlo A Liverani
- Department of Mother and Infant Sciences, Gynecologic Oncology Unit, University of Milan, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alberto Lombardi
- Scientific and Medical Consultant, Fondazione Giovanni Lorenzini, Milan, Italy and Houston, TX, USA.
| | - Luciano Mariani
- Department of Gynecologic Oncology, HPV Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Francesco Saverio Mennini
- Faculty of Economics, University of Rome Tor Vergata, Faculty of Statistics, University of Rome La Sapienza, Kingston University, London, UK.
| | - David A Mitchell
- Bradford Teaching Hospitals NHS Foundation Trust, St. Lukes Hospital, Bradford, UK.
| | - Andrea Peracino
- Fondazione Giovanni Lorenzini Medical Science Foundation, Milan, Italy and Houston, TX, USA.
| | | | - Giovanni Rezza
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Carlo Signorelli
- Department S.Bi.Bi.T., Unit of Public Health, University of Parma, Parma, Italy.
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Biomedical and Clinical Science Department, University of Milan, Milan, Italy.
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Evaluating the Early Benefit of Quadrivalent HPV Vaccine on Genital Warts in Belgium: A Cohort Study. PLoS One 2015; 10:e0132404. [PMID: 26147096 PMCID: PMC4492693 DOI: 10.1371/journal.pone.0132404] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/14/2015] [Indexed: 11/21/2022] Open
Abstract
Genital warts (GWs) are common, with about 5% to 10% of people having at least one episode in their lifetime. They develop about 2–3 months after infection with human papillomavirus (HPV) genotypes 6 and 11. The prophylactic quadrivalent HPV vaccine (qHPV), protects against HPV6/11 infections and diseases. In Belgium, HPV vaccines started to be reimbursed in 2007 and have been fully reimbursed since December 2008 for women 12 to 18 years old. This study aimed at evaluating the real-life benefit of qHPV vaccine introduction in Belgium on GWs by measuring both vaccine impact (VI) at a population level and the direct effect of the qHPV vaccine at an individual level (vaccine effectiveness (VE)), using data from a large sick-fund (MLOZ) reimbursement database. A first reimbursement for imiquimod (most common first-line GWs treatment in Belgium) was used as a surrogate for a first GWs episode; reimbursement of qHPV vaccine was used as surrogate for vaccination. VI was estimated by comparing the incidence of GWs before and after qHPV vaccine introduction in Belgium (ecologic evaluation). VE was assessed by comparing GWs incidences in vaccinated vs. unvaccinated women, among women eligible for HPV vaccination. VI was evaluated in 9,223,384 person-years. Overall, GWs incidence rates decreased significantly between the pre- and post-vaccination periods (-8.1% (95% CI: -15.3; -0.3) for men and women aged 18–59 years. This decrease was highest in women targeted by the HPV vaccination programme (-72.1% (95% CI: -77.9; -64.7) in women aged 16–22 years, with a 43% vaccine uptake in 2013). A significant decrease was also observed in men aged 16-22 years (-51.1%, 95%CI: -67.6; -26.2), suggesting herd-protection. VE was evaluated in 369,881 person-years. Age-adjusted VE for fully vaccinated women was 88.0% (95% CI: 79.4; 93.0). VE was higher when the first dose was given younger and remained high for over 4 years post-vaccination in all ages. High VI and VE of the qHPV vaccine were observed in a real-life setting in Belgium.
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Evaluation of the Long-Term Anti-Human Papillomavirus 6 (HPV6), 11, 16, and 18 Immune Responses Generated by the Quadrivalent HPV Vaccine. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:943-8. [PMID: 26084514 DOI: 10.1128/cvi.00133-15] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/09/2015] [Indexed: 12/14/2022]
Abstract
This quadrivalent human papillomavirus (qHPV) (HPV6, -11, -16, and -18) vaccine long-term follow-up (LTFU) study is an ongoing extension of a pivotal clinical study (FUTURE II) taking place in the Nordic region. The LTFU study was designed to evaluate the effectiveness, immunogenicity, and safety of the qHPV vaccine (Gardasil) for at least 10 years following completion of the base study. The current report presents immunogenicity data from testing samples of the year 5 LTFU visit (approximately 9 years after vaccination). FUTURE II vaccination arm subjects, who consented to being followed in the LTFU, donated serum at regular intervals and in 2012. Anti-HPV6, -11, -16, and -18 antibodies were detected by the competitive Luminex immunoassay (cLIA), and in addition, serum samples from 2012 were analyzed by the total IgG Luminex immunoassay (LIA) (n = 1,598). cLIA geometric mean titers (GMTs) remained between 70% and 93% of their month 48 value depending on HPV type. For all HPV types, the lower bound of the 95% confidence interval (CI) for the year 9 GMTs remained above the serostatus cutoff value. The proportion of subjects who remained seropositive based on the IgG LIA was higher than the proportion based on cLIA, especially for anti-HPV18. As expected, the anti-HPV serum IgG and cLIA responses were strongly correlated for all HPV types. Anti-HPV GMTs and the proportion of vaccinated individuals who are seropositive remain high for up to 9 years of follow-up after vaccination.
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Pils S, Joura EA. From the monovalent to the nine-valent HPV vaccine. Clin Microbiol Infect 2015; 21:827-33. [PMID: 25980355 DOI: 10.1016/j.cmi.2015.05.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 04/29/2015] [Accepted: 05/02/2015] [Indexed: 11/28/2022]
Abstract
An investigational monovalent human papillomavirus (HPV) 16 virus-like particle vaccine has been shown to prevent persistent infection and cervical disease related to HPV 16 and was proof of concept (2002). Designed to prevent the bulk of invasive cervical cancer, quadrivalent (HPV 6/11/16/18) and bivalent (HPV 16/18) vaccines have been available since 2006 and 2007, respectively. They are highly effective in preventing HPV 16/18-related cervical precancer; the quadrivalent version also prevents genital warts related to HPV 6/11. It has been shown that the precursors of vulvar, vaginal and anal cancer related to the vaccine types are effectively prevented. This led to a paradigm shift from a female-only cervical cancer vaccine to a vaccine for the prevention of HPV-related disease and cancer for both sexes. Vaccination before the start of sexual activity is most effective, and consequently most programs target 9- to 12-year-olds. Additionally, recent studies have proven the noninferior immunoresponse of a two-dose schedule in these age cohorts. Gender-neutral vaccination has become more common; it improves coverage and also provides protection to all males. Recently a nine-valent HPV vaccine (HPV 6/11/16/18/31/33/45/52/58) was licensed; it provides high and consistent protection against infections and diseases related to these types, with ∼90% of cervical and other HPV-related cancers and precancers potentially being avoided. Coverage is key. Efforts must be made to provide HPV vaccination in low-resource countries that lack screening programs. In countries with cervical cancer screening, HPV vaccination will greatly affect screening algorithms.
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Affiliation(s)
- S Pils
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - E A Joura
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Vacuna frente al virus del papiloma humano. Eficacia y seguridad. Enferm Infecc Microbiol Clin 2015; 33:342-54. [DOI: 10.1016/j.eimc.2015.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/30/2022]
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Petráš M, Adámková V. Rates and predictors of genital warts burden in the Czech population. Int J Infect Dis 2015; 35:29-33. [PMID: 25869075 DOI: 10.1016/j.ijid.2015.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/30/2015] [Accepted: 04/03/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the burden and the predictors of genital warts (GWs) in Czech men and women. METHODS A population-based cross-sectional study was conducted of 32 974 randomly selected health clinic attendees from all 14 regions of the Czech Republic. Information on GWs and lifestyle behaviour was collected using a questionnaire. RESULTS Results revealed a 5.8% prevalence rate of self-reported GWs in the Czech population aged 16-55 years. There was an increase in the incidence of GWs in the years 2010-2013 when compared to lifetime incidence rates, from 205.4 (95% confidence interval (CI) 191.0-219.7) to 441.8 (95% CI 393.1-490.6) per 100 000 person-years. No significant differences were observed between genders. The strongest risk factors found for GWs were an infected sexual partner (adjusted odds ratio (OR) 114.3, 95% CI 78.9-165.4) and a high number of lifetime sexual partners (adjusted OR 3.36, 95% CI 2.72-4.17 for >14 partners vs. one partner). A novel finding was that 22.7% (95% CI 20.9-24.6%) of participants claimed that the pathology had disappeared spontaneously without medical assistance. CONCLUSIONS The results provide baseline information for the development and monitoring of prevention strategies against GWs in the Czech Republic.
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Affiliation(s)
- Marek Petráš
- Charles University in Prague, Second Faculty of Medicine, V Úvalu 84, 150 06 Prague 5, Czech Republic.
| | - Věra Adámková
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Regan DG, Hocking JS. Greatest effect of HPV vaccination from school-based programmes. THE LANCET. INFECTIOUS DISEASES 2015; 15:497-8. [PMID: 25744473 DOI: 10.1016/s1473-3099(15)70078-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- David G Regan
- The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.
| | - Jane S Hocking
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC 3010, Australia
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