Non-Vaccine-type human papillomavirus prevalence after Vaccine introduction: No evidence for type replacement but evidence for cross-protection

Mónica Saccucci, Eduardo L. Franco, Lili Ding, David I. Bernstein, Darron Brown, Jessica A. Kahn

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background We examined non-vaccine-type human papillomavirus (HPV) prevalence in a community before and during the first 8 years after vaccine introduction, to assess for (1) type replacement with any non-vaccine-type HPV and (2) cross-protection with non-vaccine types genetically related to vaccine-type HPV. Methods Sexually experienced 13- to- 26-year-old women were recruited for 3 cross-sectional studies from 2006 to 2014 (N = 1180). Outcome variables were as follows: (1) prevalence of at least 1 of 32 anogenital non-vaccine-type HPVs and (2) prevalence of at least 1 HPV type genetically related to HPV-16 and HPV-18. We determined changes in proportions of non-vaccine-type HPV prevalence across the study waves using logistic regression with propensity score inverse probability weighting. Results Vaccine initiation rates increased from 0% to 71.3%. Logistic regression demonstrated that from 2006 to 2014, there was no increase in non-vaccine-type HPV among vaccinated women (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 0.73-1.42), but an increase among unvaccinated women (AOR, 1.88; 95% CI, 1.16-3.04). Conversely, there was a decrease in types genetically related to HPV-16 among vaccinated (AOR, 0.57; 95% CI, 0.38-0.88) but not unvaccinated women (AOR, 1.33; 95% CI, 0.81-2.17). Conclusions We did not find evidence of type replacement, but did find evidence of cross-protection against types genetically related to HPV-16. These findings have implications for cost-effectiveness analyses, which may impact vaccine-related policies, and provide information to assess the differential risk for cervical cancer in unvaccinated and vaccinated women, which may influence clinical screening recommendations. The findings also have implications for public health programs, such as health messaging for adolescents, parents, and clinicians about HPV vaccination.

Original languageEnglish (US)
Pages (from-to)260-265
Number of pages6
JournalSexually transmitted diseases
Volume45
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Cross Protection
Vaccines
Human papillomavirus 16
Odds Ratio
Confidence Intervals
Cross-Sectional Studies
Logistic Models
Papillomavirus Vaccines
Human papillomavirus 18
Propensity Score
Uterine Cervical Neoplasms
Cost-Benefit Analysis
Vaccination
Public Health
Parents

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Non-Vaccine-type human papillomavirus prevalence after Vaccine introduction : No evidence for type replacement but evidence for cross-protection. / Saccucci, Mónica; Franco, Eduardo L.; Ding, Lili; Bernstein, David I.; Brown, Darron; Kahn, Jessica A.

In: Sexually transmitted diseases, Vol. 45, No. 4, 01.04.2018, p. 260-265.

Research output: Contribution to journalArticle

Saccucci, Mónica ; Franco, Eduardo L. ; Ding, Lili ; Bernstein, David I. ; Brown, Darron ; Kahn, Jessica A. / Non-Vaccine-type human papillomavirus prevalence after Vaccine introduction : No evidence for type replacement but evidence for cross-protection. In: Sexually transmitted diseases. 2018 ; Vol. 45, No. 4. pp. 260-265.
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abstract = "Background We examined non-vaccine-type human papillomavirus (HPV) prevalence in a community before and during the first 8 years after vaccine introduction, to assess for (1) type replacement with any non-vaccine-type HPV and (2) cross-protection with non-vaccine types genetically related to vaccine-type HPV. Methods Sexually experienced 13- to- 26-year-old women were recruited for 3 cross-sectional studies from 2006 to 2014 (N = 1180). Outcome variables were as follows: (1) prevalence of at least 1 of 32 anogenital non-vaccine-type HPVs and (2) prevalence of at least 1 HPV type genetically related to HPV-16 and HPV-18. We determined changes in proportions of non-vaccine-type HPV prevalence across the study waves using logistic regression with propensity score inverse probability weighting. Results Vaccine initiation rates increased from 0{\%} to 71.3{\%}. Logistic regression demonstrated that from 2006 to 2014, there was no increase in non-vaccine-type HPV among vaccinated women (adjusted odds ratio [AOR], 1.02; 95{\%} confidence interval [CI], 0.73-1.42), but an increase among unvaccinated women (AOR, 1.88; 95{\%} CI, 1.16-3.04). Conversely, there was a decrease in types genetically related to HPV-16 among vaccinated (AOR, 0.57; 95{\%} CI, 0.38-0.88) but not unvaccinated women (AOR, 1.33; 95{\%} CI, 0.81-2.17). Conclusions We did not find evidence of type replacement, but did find evidence of cross-protection against types genetically related to HPV-16. These findings have implications for cost-effectiveness analyses, which may impact vaccine-related policies, and provide information to assess the differential risk for cervical cancer in unvaccinated and vaccinated women, which may influence clinical screening recommendations. The findings also have implications for public health programs, such as health messaging for adolescents, parents, and clinicians about HPV vaccination.",
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AB - Background We examined non-vaccine-type human papillomavirus (HPV) prevalence in a community before and during the first 8 years after vaccine introduction, to assess for (1) type replacement with any non-vaccine-type HPV and (2) cross-protection with non-vaccine types genetically related to vaccine-type HPV. Methods Sexually experienced 13- to- 26-year-old women were recruited for 3 cross-sectional studies from 2006 to 2014 (N = 1180). Outcome variables were as follows: (1) prevalence of at least 1 of 32 anogenital non-vaccine-type HPVs and (2) prevalence of at least 1 HPV type genetically related to HPV-16 and HPV-18. We determined changes in proportions of non-vaccine-type HPV prevalence across the study waves using logistic regression with propensity score inverse probability weighting. Results Vaccine initiation rates increased from 0% to 71.3%. Logistic regression demonstrated that from 2006 to 2014, there was no increase in non-vaccine-type HPV among vaccinated women (adjusted odds ratio [AOR], 1.02; 95% confidence interval [CI], 0.73-1.42), but an increase among unvaccinated women (AOR, 1.88; 95% CI, 1.16-3.04). Conversely, there was a decrease in types genetically related to HPV-16 among vaccinated (AOR, 0.57; 95% CI, 0.38-0.88) but not unvaccinated women (AOR, 1.33; 95% CI, 0.81-2.17). Conclusions We did not find evidence of type replacement, but did find evidence of cross-protection against types genetically related to HPV-16. These findings have implications for cost-effectiveness analyses, which may impact vaccine-related policies, and provide information to assess the differential risk for cervical cancer in unvaccinated and vaccinated women, which may influence clinical screening recommendations. The findings also have implications for public health programs, such as health messaging for adolescents, parents, and clinicians about HPV vaccination.

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