Potential population-level effectiveness of one-dose HPV vaccination in low-income and middle-income countries: a mathematical modelling analysis

Bénard, Élodie; Drolet, Mélanie; Laprise, Jean-François; Gingras, Guillaume; Jit, Mark; Boily, Marie-Claude; Bloem, Paul; Brisson, Marc

doi:10.1016/s2468-2667(23)00180-9

Cited by 15 publications

(10 citation statements)

References 20 publications

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“…Thus, consistent evidence on the efficacy and durability of single-dose HPV vaccination supports the WHO guidance for single-dose implementation to increase vaccine coverage. In mathematical modeling analyses of scale-up, implementation of routine single-dose immunization has the potential to avert most cervical cancer cases compared to two doses, with a durability of 20–30 years, in low-HDI settings 21 . Further, single-dose vaccination can increase coverage among girls in the 9–14-year-old group before they age out of vaccine eligibility and provide catch-up vaccination for those who may have missed the immunization due to the COVID-19 pandemic or other reasons.…”

Section: Discussionmentioning

confidence: 99%

Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results

Barnabas,

Brown,

Onono

et al. 2023

Nat Med

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Cervical cancer burden is high where prophylactic vaccination and screening coverage are low. We demonstrated in a multicenter randomized, double-blind, controlled trial that single-dose human papillomavirus (HPV) vaccination had high vaccine efficacy (VE) against persistent infection at 18 months in Kenyan women. Here, we report findings of this trial through 3 years of follow-up. Overall, 2,275 healthy women aged 15–20 years were recruited and randomly assigned to receive bivalent (n = 760), nonavalent (n = 758) or control (n = 757) vaccine. The primary outcome was incident-persistent vaccine type-specific cervical HPV infection. The primary evaluation was superiority analysis in the modified intention-to-treat (mITT) HPV 16/18 and HPV 16/18/31/33/45/52/58 cohorts. The trial met its prespecified end points of vaccine type-specific persistent HPV infection. A total of 75 incident-persistent infections were detected in the HPV 16/18 mITT cohort: 2 in the bivalent group, 1 in the nonavalent group and 72 in the control group. Nonavalent VE was 98.8% (95% CI 91.3–99.8%, P < 0.0001) and bivalent VE was 97.5% (95% CI 90.0–99.4%, P < 0.0001). Overall, 89 persistent infections were detected in the HPV 16/18/31/33/45/52/58 mITT cohort: 5 in the nonavalent group and 84 in the control group; nonavalent VE was 95.5% (95% CI 89.0–98.2%, P < 0.0001). There were no vaccine-related severe adverse events. Three years after vaccination, single-dose HPV vaccination was highly efficacious, safe and conferred durable protection. ClinicalTrials.gov no. NCT03675256.

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Section: Discussionmentioning

confidence: 99%

Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results

Barnabas,

Brown,

Onono

et al. 2023

Nat Med

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“…A 2-dose regimen was assumed to provide lifetime protection [6,49,50]. Given that there was no evidence of waning in vaccine protection after a single dose over more than 10 years of follow-up in the Indian and CVT studies [17,51], we conservatively assumed a 30-year duration of protection for single-dose strategies [49]. Herein, for cervical cancer, the degree of 2-dose 2vHPV vaccination protection was given as 0.70, and the degree of 2-dose 9vHPV vaccination protection was set as 0.90 [50].…”

Section: Vaccine Efficacymentioning

confidence: 99%

“…The threshold analyses were carried out Notes: parative evidence for the efficacy and effectivethat the duration of protection and efficacy proinferior to that of a 2-dose vaccine. A 2-dose regrotection [6,49,50]. Given that there was no eviter a single dose over more than 10 years of fol-,51], we conservatively assumed a 30-year duraes [49].…”

Section: Sensitivity Analysesmentioning

confidence: 99%

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Modeling the Health Impact and Cost-Effectiveness of a Combined Schoolgirl HPV Vaccination and Cervical Cancer Screening Program in Guangdong Province, China

Huang,

Zhang,

Yin

et al. 2024

Children

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Low human papillomavirus (HPV) vaccine uptake is a key barrier to cervical cancer elimination. We aimed to evaluate the health impact and cost-effectiveness of introducing different HPV vaccines into immunization programs and scaling up the screening program in Guangdong. We used a dynamic compartmental model to estimate the impact of intervention strategies during 2023–2100. We implemented the incremental cost-effectiveness ratio (ICER) in costs per averted disability-adjusted life year (DALY) as an indicator to assess the effectiveness of the intervention. We used an age-standardized incidence of 4 cases per 100,000 women as the threshold for the elimination of cervical cancer. Compared with the status quo, scaling up cervical cancer screening coverage alone would prevent 215,000 (95% CI: 205,000 to 227,000) cervical cancer cases and 49,000 (95% CI: 48,000 to 52,000) deaths during 2023–2100. If the coverage of vaccination reached 90%, domestic two-dose 2vHPV vaccination would be more cost-effective than single-dose and two-dose 9vHPV vaccination. If Guangdong introduced domestic two-dose 2vHPV vaccination at 90% coverage for schoolgirls from 2023 and increased the screening coverage, cervical cancer would be eliminated by 2049 (95% CI 2047 to 2051). Introducing two doses of domestic 2vHPV vaccination for schoolgirls and expanding cervical cancer screening is estimated to be highly cost-effective to accelerate the elimination of cervical cancer in Guangdong.

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“…Since then, updated data from the Costa Rica HPV Vaccine Trial (CVT) showed stable antibodies up to 16 years after one dose vaccination 5 and the Kenya single-dose HPV-vaccine efficacy randomised-controlled trial (KEN SHE RCT) showed 98% one-dose efficacy after 36 months 6 . The SAGE announcement was also based on modeling suggesting that one-dose vaccination could lead to similar population-level reductions in cervical cancers in low- and middle-income countries (LMICs) as two doses whilst being a more efficient use of vaccine doses, if one-dose duration of protection lasts longer than 20 years 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Potential impact of switching from a two- to one-dose gender-neutral routine HPV vaccination program in Canada: A mathematical modeling analysis

Drolet,

Laprise,

Chamberland

et al. 2024

Preprint

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BackgroundWorldwide, countries are examining whether to implement one-dose HPV vaccination. To inform policy recommendations in Canada, we used mathematical modeling to project the population-level impact and efficiency of switching from two-to one-dose gender-neutral routine HPV vaccination.MethodsWe used HPV-ADVISE, an individual-based transmission-dynamic model of HPV infections/diseases, to model 2 provinces (Quebec, Ontario), which represent higher (≈85%) and lower (≈65%) HPV vaccination coverage in Canada. We examined non-inferior and pessimistic scenarios of one-dose efficacy (VE=98%, 90%) and average duration (VD=lifelong, 30 years, 25 years) versus two doses (VE=98%, VD=lifelong). Our main outcomes were the relative reduction in HPV-16 (among females/males) and cervical cancers, and the number of doses needed to prevent one cervical cancer (NNV).ResultsOur model projects that one-dose HPV vaccination would avert a similar number of cervical cancers as two doses in Canada, under various non-inferior and pessimistic scenarios. Under the most pessimistic scenario (VD=25 years), one-dose vaccination would avert ∼3 percentage-points fewer cervical cancers than two doses over 100 years. All one-dose scenarios were projected to lead to cervical cancer elimination and were projected to be a substantially more efficient use of vaccine doses compared to two doses (NNVs one-dose vs no vaccination=800-1000; incremental NNVs two-dose vs one-dose vaccination >10,000).InterpretationIf the average duration of one-dose protection is longer than 25 years, individuals would be protected during their peak ages of sexual activity and one-dose vaccination would prevent a similar number of HPV-related cancers, while being a more efficient use of vaccine doses.

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Potential population-level effectiveness of one-dose HPV vaccination in low-income and middle-income countries: a mathematical modelling analysis

Cited by 15 publications

References 20 publications

Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results

Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results

Modeling the Health Impact and Cost-Effectiveness of a Combined Schoolgirl HPV Vaccination and Cervical Cancer Screening Program in Guangdong Province, China

Potential impact of switching from a two- to one-dose gender-neutral routine HPV vaccination program in Canada: A mathematical modeling analysis

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