Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models

Brisson, Marc; Bénard, Élodie; Drolet, Mélanie; Bogaards, Johannes A.; Baussano, Iacopo; Vänskä, Simopekka; Jit, Mark; Boily, Marie‐Claude; Smith, Megan A.; Berkhof, Johannes; Canfell, Karen; Chesson, Harrell W.; Burger, Emily A.; Choi, Yoon Hong; Blasio, Birgitte Freiesleben de; Vlas, Sake J. de; Guzzetta, Giorgio; Hontelez, Jan A. C.; Horn, Johannes; Jepsen, Martin Rudbeck; Kim, Jane J.; Lazzarato, Fulvio; Matthijsse, Suzette M.; Mikolajczyk, Rafael; Pavelyev, A.; Pillsbury, Matthew; Shafer, Leigh Anne; Tully, Stephen; Turner, Hugo C.; Usher, Cara; Walsh, Cathal

doi:10.1016/s2468-2667(16)30001-9

Cited by 249 publications

(217 citation statements)

References 45 publications

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“…This observation may be a reflection of the change in the epidemiology of HPV in women over time related to increased uptake of vaccine and herd immunity, as described in other populations [36], [37], [38], [39]. Equally these women may have had more years of undetectable plasma HIV-1 RNA and have been heavily screened with Pap tests and colposcopy due to their increased burden of HPV disease.…”

Section: Discussionmentioning

confidence: 92%

Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1

Cespedes

Kang

Kojic

et al. 2018

Papillomavirus Research

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ObjectivesPeople living with HIV have increased Human Papillomavirus (HPV) related lesions and malignancies. We describe HPV DNA recovered from the cervix and anal canal, explore the effect of vaccination on HPV detection, and examine the durability of vaccine titers in women living with HIV-1 who were vaccinated with the quadrivalent HPV vaccine.MethodsAIDS Clinical Trials Group A5240 was a prospective study of the quadrivalent HPV (qHPV) vaccine in 315 HIV-1 infected women in three CD4 strata (A: >350, B; 201–350, C: ≤200 cells/mm3). Vaccine was administered at entry, week 8 and week 24. Cervical and anal HPV DNA specimens were collected at baseline, weeks 28 and 52; serum for antibody testing was obtained at baseline, weeks 28 and 72.ResultsVaccine antibody titers decreased across all four HPV types at week 72 compared to week 28. Lower proportions of sustained seropositivity were observed in women with lower CD4 counts for all four vaccine types, with the lowest titers for HPV 18. Despite the decrease, the geometric mean titer levels were above the seroconversion cut-off levels for all types except HPV 18 in the lowest CD4 stratum. Of the 174 participants who had a negative baseline HPV 16 antibody and developed antibody response at week 28, 95%, 88%, and 86% retained seropositivity at week 72 in strata A, B, and C respectively. Lower antibody retention was observed in women with CD4 < 200 compared to CD4 > 350 (p = 0.016). Anal HPV detection was more prevalent compared to cervical detection at all visits. Among high risk types, type 52, 31, 16, 18 and 51 were the most common in the cervical compartment, while types 16, 35, 18, and 51 were the most prevalent in the anal canal at baseline (listed in the order of prevalence). Later detection of HPV not present at baseline was uncommon in either compartment. Serial recovery of HPV over time was more commonly observed in the anal canal.ConclusionThe qHPV vaccine elicits durable titer response above the seroconversion cut-off levels in HIV-infected women. However, the titer levels were substantially lower by Week 72, most noticeably in type 18. HPV DNA was detected more frequently in the anal canal. Detection of non-vaccine high risk HPV suggests a role for the nonavalent vaccine.

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Section: Discussionmentioning

confidence: 92%

Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1

Cespedes

Kang

Kojic

et al. 2018

Papillomavirus Research

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“…Transmission models can capture the dynamics of infection circulation10 in a population and have the distinct advantage of including the effect of herd immunity 31. We could also derive estimates of the parameters governing the natural history of HPV16 infections from the calibration to a large screening trial conducted in Italy18 in which we were able to predict accurately the incidence of HPV16 infection in HPV16 negative women 11.…”

Section: Discussionmentioning

confidence: 99%

Impacts of human papillomavirus vaccination for different populations: A modeling study

Baussano

Lazzarato

Ronco³

et al. 2018

Intl Journal of Cancer

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International variations in the prevalence of HPV infection derive from differences in sexual behaviors, which are also a key factor of the basic reproductive number (R0) of HPV infection in different populations. R 0 affects the strength of herd protection and hence the impact of a vaccination program. Similar vaccination programs may therefore generate different levels of impact depending upon the population's pre‐vaccination HPV prevalence. We used IARC's transmission model to estimate (i) the overall effectiveness of vaccination versus no vaccination in women aged 15–34 years measured as percent prevalence reduction (%PR) of HPV16 and (ii) the corresponding herd protection in populations with gender‐equal or traditional sexual behavior and with different levels of sexual activity, corresponding to pre‐vaccination HPV16 prevalence from 1 to 8% as observed worldwide. Between populations with different levels of gender‐equal sexual activity, the highest difference in %PR under girls‐only vaccination is observed at 40% coverage (91%PR vs. 48%PR for 1% and 8% pre‐vaccination prevalence, respectively). HPV16 elimination is obtained with 55 and 97% coverage, respectively. To achieve desirable levels of HPV16 prevalence after vaccination, different levels of coverage are required in populations with different levels of pre‐vaccination HPV16 prevalence, for example, in populations with gender‐equal sexual behavior a decrease to 1/1000 HPV16 from pre‐vaccination prevalence of 1 and 8% would require coverages of 37 and 96%, respectively. In traditional populations, corresponding coverages would need to be 28 and 93%, respectively. In conclusion, pre‐vaccination HPV prevalence strongly influences herd immunity and helps predict the overall effectiveness of HPV vaccination.

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“…However, the indirect effects (or "herd effects") predicted by our simple model over the long term were generally consistent with predictions of more complex models of HPV transmission in developed settings. 28 The second main simplifying feature of our model is that it does not explicitly account for cervical cancer screening and therefore cannot examine the impact of future changes in cervical cancer screening. Instead, our model approximates the long-term costs and benefits of HPV vaccination under the assumption that the probability of detection through screening remains constant over the duration of the HPV vaccine program and that the number of cervical cancer cases would remain constant over time in the absence of vaccination.…”

Section: Discussionmentioning

confidence: 99%

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

Chesson

Markowitz

Hariri

et al. 2016

Human Vaccines & Immunotherapeutics

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Introduction: The objective of this study was to assess the incremental costs and benefits of the 9-valent HPV vaccine (9vHPV) compared with the quadrivalent HPV vaccine (4vHPV). Like 4vHPV, 9vHPV protects against HPV types 6, 11, 16, and 18. 9vHPV also protects against 5 additional HPV types 31, 33, 45, 52, and 58. Methods: We adapted a previously published model of the impact and cost-effectiveness of 4vHPV to include the 5 additional HPV types in 9vHPV. The vaccine strategies we examined were (1) 4vHPV for males and females; (2) 9vHPV for females and 4vHPV for males; and (3) 9vHPV for males and females. In the base case, 9vHPV cost $13 more per dose than 4vHPV, based on available vaccine price information. Results: Providing 9vHPV to females compared with 4vHPV for females (assuming 4vHPV for males in both scenarios) was cost-saving regardless of whether or not cross-protection for 4vHPV was assumed. The cost per quality-adjusted life year (QALY) gained by 9vHPV for both sexes (compared with 4vHPV for both sexes) was < $0 (cost-saving) when assuming no cross-protection for 4vHPV and $8,600 when assuming cross-protection for 4vHPV. Conclusions: Compared with a vaccination program of 4vHPV for both sexes, a vaccination program of 9vHPV for both sexes can improve health outcomes and can be cost-saving.

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Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models

Abstract: Canadian Institutes of Health Research.

Cited by 249 publications

References 45 publications

Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1

Anogenital human papillomavirus virus DNA and sustained response to the quadrivalent HPV vaccine in women living with HIV-1

Impacts of human papillomavirus vaccination for different populations: A modeling study

The impact and cost-effectiveness of nonavalent HPV vaccination in the United States: Estimates from a simplified transmission model

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