HPV catch-up vaccination of young women: a systematic review and meta-analysis

Abstract

BackgroundWhile prophylactic human papilloma virus (HPV) vaccination is considered effective in young girls, it is unclear whether a catch-up vaccination of older girls would be beneficial. We, therefore, aimed to examine the potential health impact of a HPV catch-up vaccination of girls who were too old at the time of vaccine introduction, hence aged 16 and older.MethodsWe systematically searched the literature for randomized clinical trials (RCTs) that examined the effect of HPV vaccines on overall mortality, cancer mortality and incidence, high-grade cervical intraepithelial neoplasia grade 2 and higher (CIN2+), vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VaIN) grade 2 and higher lesions (VIN2+ and VaIN2+, respectively) genital warts (condyloma). We considered all lesions and those associated with HPV type(s) included in the vaccines. RCTs reporting on serious adverse events were also eligible. Selected publications were assessed for potential risk of bias, and we ascertained the overall quality of the evidence for each outcome using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analyses were performed, assuming both random and fixed effects, to estimate risk ratios (RR) and corresponding 95% confidence intervals (CI), using intention-to-treat and per-protocol populations.ResultsWe included 46 publications reporting on 13 RCTs. Most of the RCTs had a maximum follow-up period of four years. We identified no RCT reporting on the effect of HPV catch vaccination on overall and cancer related mortality, and on cervical cancer incidence. We found a borderline protective effect of a HPV catch-up vaccination on all CIN2+, with a pooled RR of 0.80 (95% CI: 0.62-1.02) for a follow-up period of 4 years. A HPV catch-up vaccination was associated with a reduction in VIN2+ and VaIN2+ lesions, and condyloma. No difference in risk of serious adverse events was seen in vaccinated participants versus unvaccinated women (pooled RR of 0.99 (0.91-1.08)).ConclusionsThis systematic review indicates that a HPV catch-up vaccination could be beneficial, however the long-term effect of such a vaccination, and its effect on cervical cancer incidence and mortality is still unclear.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-867) contains supplementary material, which is available to authorized users.

A functional polymorphism in the NKG2D gene modulates NK-cell cytotoxicity and is associated with susceptibility to Human Papilloma Virus-related cancers

“…For example, in most technologically advanced countries the implementation of screening programs have resulted in a nearly 70% decrease in cervical cancer rates over the past 40 years28, indicating that prevention is a valuable strategy for reducing the economic and disease burden of HPV infection. HPV-related cancer prevention programs will further benefit from the approval and broad application of two successful prophylactic HPV vaccines—quadrivalent (HPV16/18/6/11) ‘Gardasil’ and bivalent (HPV16/18) ‘Cervarix’—for vaccinating young adolescent girls at or before the onset of puberty29, which, as supported by recently published data, prevents the development of cervical lesions in young women, particularly those who have not been infected with vaccine-specific HPV types2930.…”

Knowledge of HPV and HPV Vaccine among Women Ages 19 to 26

“…Young people in this "catch-up" period are considered the last chance group to benefit from the HPV vaccine (Couto, Saeterdal, Juvet, & Klemp, 2014). Despite these recommendations, data from the National Health Interview Study indicate that 77% of 18-to 26-year-old women have not been vaccinated against HPV, with another 10% incompletely vaccinated (Laz, Rahman, & Berenson, 2013).…”

Prevalence of HPV infection among 28,457 Chinese women in Yunnan Province, southwest China

“…Two HPV vaccines, a bivalent vaccine that targets HPV types 16 and 18 and a quadrivalent vaccine that targets types HPV6, 11, 16 and 18, are the most effective at reducing the risk of cervical cancer if they are administered prior to HPV exposure 5 6 7 . However, in addition to HPV16 and 18, the other high-risk types, including HPV31, 45, 52 and 58, account for approximately 10–20% of cervical cancers 2 .…”