Human papillomavirus vaccine effectiveness and herd protection in young women

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

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Clinical trials of the 4-valent human papillomavirus (HPV) vaccine demonstrate high efficacy, but surveillance studies are essential to examine the long-term impact of vaccine introduction on HPV prevalence in community settings. The aims of this study were to determine during the 11 years after vaccine introduction the prevalence of (1) vaccine-type HPV in adolescent and young adult women who were vaccinated (to assess vaccine effectiveness) and (2) vaccine-type HPV in women who were unvaccinated (to assess herd protection). METHODS: Young women 13 to 26 years of age were recruited from hospital-based and community health clinics for 4 surveillance studies from 2006 to 2017. We determined the proportion of vaccinated and unvaccinated women who were positive for vaccine-type HPV across the studies, and the odds of positivity for vaccine-type HPV using logistic regression; all analyses were propensity score–adjusted to control for between-wave differences in participant characteristics. RESULTS: Vaccination rates increased from 0% to 84.3% (97% of study participants received the 4-valent vaccine). Among women who were vaccinated, 4-valent vaccine–type HPV detection decreased from 35% to 6.7% (80.9% decline; odds ratio 0.13, 95% confidence interval 0.08 to 0.22). Among women who were unvaccinated, 4-valent vaccine–type HPV detection decreased from 32.4% to 19.4% (40% decline; odds ratio 0.50, 95% confidence interval 0.26 to 0.97). Estimated vaccine effectiveness was 90.6% in wave 3 and 80.1% in wave 4. CONCLUSIONS: In this study in which trends in HPV in a US community >10 years after 4-valent HPV vaccine introduction and after 9-valent vaccine introduction were examined, we found evidence of vaccine effectiveness and herd protection. Further research is needed to examine trends in 9-valent vaccine–type HPV after higher rates of vaccination are achieved.

Original languageEnglish (US)
Article numbere20181902
JournalPediatrics
Volume143
Issue number2
DOIs
StatePublished - Feb 1 2019

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Papillomavirus Vaccines
Vaccines
Vaccination
Odds Ratio
Confidence Intervals
Young Adult
Logistic Models
Clinical Trials
Health
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Spinner, C., Ding, L., Bernstein, D. I., Brown, D., Franco, E. L., Covert, C., & Kahn, J. A. (2019). Human papillomavirus vaccine effectiveness and herd protection in young women. Pediatrics, 143(2), [e20181902]. https://doi.org/10.1542/peds.2018-1902

Human papillomavirus vaccine effectiveness and herd protection in young women. / Spinner, Chelse; Ding, Lili; Bernstein, David I.; Brown, Darron; Franco, Eduardo L.; Covert, Courtney; Kahn, Jessica A.

In: Pediatrics, Vol. 143, No. 2, e20181902, 01.02.2019.

Research output: Contribution to journalArticle

Spinner, C, Ding, L, Bernstein, DI, Brown, D, Franco, EL, Covert, C & Kahn, JA 2019, 'Human papillomavirus vaccine effectiveness and herd protection in young women', Pediatrics, vol. 143, no. 2, e20181902. https://doi.org/10.1542/peds.2018-1902
Spinner C, Ding L, Bernstein DI, Brown D, Franco EL, Covert C et al. Human papillomavirus vaccine effectiveness and herd protection in young women. Pediatrics. 2019 Feb 1;143(2). e20181902. https://doi.org/10.1542/peds.2018-1902
Spinner, Chelse ; Ding, Lili ; Bernstein, David I. ; Brown, Darron ; Franco, Eduardo L. ; Covert, Courtney ; Kahn, Jessica A. / Human papillomavirus vaccine effectiveness and herd protection in young women. In: Pediatrics. 2019 ; Vol. 143, No. 2.
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abstract = "BACKGROUND: Clinical trials of the 4-valent human papillomavirus (HPV) vaccine demonstrate high efficacy, but surveillance studies are essential to examine the long-term impact of vaccine introduction on HPV prevalence in community settings. The aims of this study were to determine during the 11 years after vaccine introduction the prevalence of (1) vaccine-type HPV in adolescent and young adult women who were vaccinated (to assess vaccine effectiveness) and (2) vaccine-type HPV in women who were unvaccinated (to assess herd protection). METHODS: Young women 13 to 26 years of age were recruited from hospital-based and community health clinics for 4 surveillance studies from 2006 to 2017. We determined the proportion of vaccinated and unvaccinated women who were positive for vaccine-type HPV across the studies, and the odds of positivity for vaccine-type HPV using logistic regression; all analyses were propensity score–adjusted to control for between-wave differences in participant characteristics. RESULTS: Vaccination rates increased from 0{\%} to 84.3{\%} (97{\%} of study participants received the 4-valent vaccine). Among women who were vaccinated, 4-valent vaccine–type HPV detection decreased from 35{\%} to 6.7{\%} (80.9{\%} decline; odds ratio 0.13, 95{\%} confidence interval 0.08 to 0.22). Among women who were unvaccinated, 4-valent vaccine–type HPV detection decreased from 32.4{\%} to 19.4{\%} (40{\%} decline; odds ratio 0.50, 95{\%} confidence interval 0.26 to 0.97). Estimated vaccine effectiveness was 90.6{\%} in wave 3 and 80.1{\%} in wave 4. CONCLUSIONS: In this study in which trends in HPV in a US community >10 years after 4-valent HPV vaccine introduction and after 9-valent vaccine introduction were examined, we found evidence of vaccine effectiveness and herd protection. Further research is needed to examine trends in 9-valent vaccine–type HPV after higher rates of vaccination are achieved.",
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