Evidence for cross-protection but not type-replacement over the 11 years after human papillomavirus vaccine introduction

Courtney Covert, Lili Ding, Darron Brown, Eduardo L. Franco, David I. Bernstein, Jessica A. Kahn

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Examination of cross-protection and type replacement after human papillomavirus (HPV) vaccine introduction is essential to guide vaccination recommendations and policies. The aims of this study were to examine trends in non-vaccine-type HPV: 1) genetically related to vaccine types (to assess for cross-protection) and 2) genetically unrelated to vaccine types (to assess for type replacement), among young women 13–26 years of age during the 11 years after HPV vaccine introduction. Participants were recruited from a hospital-based teen health center and a community health department for four cross-sectional surveillance studies between 2006 and 2017. Participants completed a survey that assessed sociodemographic characteristics and behaviors, and cervicovaginal swabs were collected and tested for 36 HPV genotypes. We determined changes in proportions of non-vaccine-type HPV prevalence and conducted logistic regression to determine the odds of infection across the surveillance studies, propensity-score adjusted to control for selection bias. Analyses were stratified by vaccination status. Among vaccinated women who received only the 4-valent vaccine (n = 1,540), the adjusted prevalence of HPV types genetically related to HPV16 decreased significantly by 45.8% (adjusted odds ratio [AOR] = 0.48, 95% confidence interval [CI] = 0.31–0.74) from 2006–2017, demonstrating evidence of cross-protection. The adjusted prevalence of HPV types genetically related to HPV18 did not change significantly (14.2% decrease, AOR = 0.83, 95% CI = 0.56–1.21). The adjusted prevalence of HPV types genetically unrelated to vaccine types did not change significantly (4.2% increase, AOR = 1.09, CI = 0.80–1.48), demonstrating no evidence of type replacement. Further studies are needed to monitor for cross-protection and possible type replacement after introduction of the 9-valent HPV vaccine.

Original languageEnglish (US)
Pages (from-to)1962-1969
Number of pages8
JournalHuman Vaccines and Immunotherapeutics
Volume15
Issue number7-8
DOIs
StatePublished - Aug 3 2019

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Keywords

  • Cross-protection
  • human papillomavirus
  • type-replacement

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Pharmacology

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