Vaccine-type human papillomavirus and evidence of herd protection after vaccine introduction

Jessica A. Kahn, Darron Brown, Lili Ding, Lea E. Widdice, Marcia Shew, Susan Glynn, David I. Bernstein

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

OBJECTIVES: The aims of this study were to compare prevalence rates of human papillomavirus (HPV) in young women before and after HPV vaccine introduction to determine the following: (1) whether vaccine-type HPV infection decreased, (2) whether there was evidence of herd protection, and (3) whether there was evidence for type-replacement (increased prevalence of nonvaccine-type HPV). METHODS: Young women 13 to 26 years of age who had had sexual contact were recruited from 2 primary care clinics in 2006-2007 for a prevaccination surveillance study (N = 368, none were vaccinated) and 2009-2010 for a postvaccination surveillance study (N = 409, 59% were vaccinated). Participants completed a questionnaire and were tested for cervicovaginal HPV DNA. HPV prevalence rates were compared in the pre- versus postsurveillance studies by using χ 2 tests. Propensity score weighting was used to balance differences in covariates between the 2 surveillance studies. RESULTS: The mean age was ∼19 years for both groups of participants and most were African American and non-Hispanic. After propensity score weighting, the prevalence rate for vaccine-type HPV decreased substantially (31.7%-13.4%, P < .0001). The decrease in vaccine-type HPV not only occurred among vaccinated (31.8%-9.9%, P < .0001) but also among unvaccinated (30.2%-15.4%, P , .0001) postsurveillance study participants. Nonvaccine-type HPV increased (60.7%-75.9%, P < .0001) for vaccinated postsurveillance study participants. CONCLUSIONS: Four years after licensing of the quadrivalent HPV vaccine, there was a substantial decrease in vaccine-type HPV prevalence and evidence of herd protection in this community. The increase in nonvaccine-type HPV in vaccinated participants should be interpreted with caution but warrants further study.

Original languageEnglish
JournalPediatrics
Volume130
Issue number2
DOIs
StatePublished - Aug 2012

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Papillomavirus Vaccines
Vaccines
Propensity Score
Papillomavirus Infections
Licensure
Vaccine
African Americans
Primary Health Care
DNA

Keywords

  • Adolescent
  • Herd protection
  • Human papillomavirus vaccines
  • Prevalence

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Vaccine-type human papillomavirus and evidence of herd protection after vaccine introduction. / Kahn, Jessica A.; Brown, Darron; Ding, Lili; Widdice, Lea E.; Shew, Marcia; Glynn, Susan; Bernstein, David I.

In: Pediatrics, Vol. 130, No. 2, 08.2012.

Research output: Contribution to journalArticle

Kahn, Jessica A. ; Brown, Darron ; Ding, Lili ; Widdice, Lea E. ; Shew, Marcia ; Glynn, Susan ; Bernstein, David I. / Vaccine-type human papillomavirus and evidence of herd protection after vaccine introduction. In: Pediatrics. 2012 ; Vol. 130, No. 2.
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abstract = "OBJECTIVES: The aims of this study were to compare prevalence rates of human papillomavirus (HPV) in young women before and after HPV vaccine introduction to determine the following: (1) whether vaccine-type HPV infection decreased, (2) whether there was evidence of herd protection, and (3) whether there was evidence for type-replacement (increased prevalence of nonvaccine-type HPV). METHODS: Young women 13 to 26 years of age who had had sexual contact were recruited from 2 primary care clinics in 2006-2007 for a prevaccination surveillance study (N = 368, none were vaccinated) and 2009-2010 for a postvaccination surveillance study (N = 409, 59{\%} were vaccinated). Participants completed a questionnaire and were tested for cervicovaginal HPV DNA. HPV prevalence rates were compared in the pre- versus postsurveillance studies by using χ 2 tests. Propensity score weighting was used to balance differences in covariates between the 2 surveillance studies. RESULTS: The mean age was ∼19 years for both groups of participants and most were African American and non-Hispanic. After propensity score weighting, the prevalence rate for vaccine-type HPV decreased substantially (31.7{\%}-13.4{\%}, P < .0001). The decrease in vaccine-type HPV not only occurred among vaccinated (31.8{\%}-9.9{\%}, P < .0001) but also among unvaccinated (30.2{\%}-15.4{\%}, P , .0001) postsurveillance study participants. Nonvaccine-type HPV increased (60.7{\%}-75.9{\%}, P < .0001) for vaccinated postsurveillance study participants. CONCLUSIONS: Four years after licensing of the quadrivalent HPV vaccine, there was a substantial decrease in vaccine-type HPV prevalence and evidence of herd protection in this community. The increase in nonvaccine-type HPV in vaccinated participants should be interpreted with caution but warrants further study.",
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