Ecological Association of Human Papillomavirus Vaccination with Cervical Dysplasia Prevalence in the United States, 2007–2014

Flagg, Elaine W.; Torrone, Elizabeth; Weinstock, Hillard

doi:10.2105/ajph.2016.303472

Cited by 43 publications

(35 citation statements)

References 39 publications

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“…In our analysis, reductions in 4vHPV-type prevalence remained significant after multivariable adjustment for both demographics and sexual behaviors. Our findings of declining prevalence of 4vHPV types among females aged 14–19 years and 20–24 years are consistent with ecologic studies that have documented declines in genital warts and precancer lesions among women in their early 20s; however, these prior studies did not adjust for possible changes in sexual behavior [26, 27]. The specificity of declines to 4vHPV types in our adjusted analyses further supports the conclusion that the vaccination program is primarily responsible for the observed declines in HPV prevalence.…”

Section: Discussionsupporting

confidence: 87%

Prevalence of Human Papillomavirus Among Females After Vaccine Introduction—National Health and Nutrition Examination Survey, United States, 2003–2014

Oliver

Unger

Lewis

et al. 2017

The Journal of Infectious Diseases

127

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Background Human papillomavirus (HPV) vaccine was recommended in 2006 for routine vaccination of US females aged 11–12 years. Most vaccine used through 2014 was quadrivalent vaccine (4vHPV), which prevents HPV-6, -11, -16, and -18 infection. To evaluate vaccine impact, we measured HPV prevalence in the National Health and Nutrition Examination Survey (NHANES). Methods We analyzed HPV DNA types detected in self-collected cervicovaginal specimens and demographic, sexual behavior, and self-reported vaccination data from females 14–34 years old. We estimated HPV prevalence in the prevaccine (2003–2006) and vaccine eras (2007–2010 and 2011–2014). Results Among 14- to 19-year-olds, 4vHPV-type prevalence decreased from 11.5% (95% confidence interval [CI], 9.1%–14.4%) in 2003–2006 to 3.3% (95% CI, 1.9%–5.8%) in 2011–2014, when ≥1-dose coverage was 55%. Among 20- to 24-year-olds, prevalence decreased from 18.5% (95% CI, 14.9%–22.8%) in 2003–2006 to 7.2% (95% CI, 4.7%–11.1%) in 2011–2014, when ≥1-dose coverage was 43%. Compared to 2003–2006, 4vHPV prevalence in sexually active 14- to 24-year-olds in 2011–2014 decreased 89% among those vaccinated and 34% among those unvaccinated. Vaccine effectiveness was 83%. Conclusions Within 8 years of vaccine introduction, 4vHPV-type prevalence decreased 71% among 14- to 19-year-olds and 61% among 20- to 24-year-olds. Estimated vaccine effectiveness was high. The decrease in 4vHPV-type prevalence among unvaccinated females suggests herd protection.

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Section: Discussionsupporting

confidence: 87%

Prevalence of Human Papillomavirus Among Females After Vaccine Introduction—National Health and Nutrition Examination Survey, United States, 2003–2014

Oliver

Unger

Lewis

et al. 2017

The Journal of Infectious Diseases

127

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“…No declines were observed in the oldest age group who were not age-eligible to receive the HPV vaccine during the surveillance period in this analysis. In prior studies of CIN2þ incidence, vaccine impact has not yet been observed among women over the age of 24 years, and rates of CIN2þ calculated among screened women in age groups 25 and older have actually increased (9,10,17). By histologic grade, declining trends were observed in CIN2 and CIN2/3 only.…”

Section: Discussionmentioning

confidence: 93%

“…Previously, vaccine impact on CIN2þ has been observed through a declining incidence among screened young women. Within eight years of vaccine introduction, significant declines in the rate of CIN2þ were observed in a statewide registry among screened [15][16][17][18][19] year olds and 20-24 year olds, (9) and in [15][16][17][18][19] year olds in a large claims database for the privately insured (17). HPV-IMPACT has also observed a decline in rates of CIN2þ among young women (8,10,18).…”

Section: Discussionmentioning

confidence: 99%

“…Women >30 years-old are recommended to have a high-risk HPV test performed in addition to cytology (11). Some studies have accounted for these changes by measuring incidence among women screened for cervical cancer (9,10,17). Furthermore, observation rather than immediate referral to colposcopy was recommended in 21-24 year olds with low-grade cytology (24).…”

Section: Discussionmentioning

confidence: 99%

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Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008–2014

McClung

Gargano

Bennett

et al. 2019

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: The impact of human papillomavirus (HPV) vaccination has been observed in the United States through declining cervical precancer incidence in young women. To further evaluate vaccine impact, we described trends in HPV vaccine types 16/18 in cervical precancers, 2008-2014. Methods: We analyzed data from a 5-site, population-based surveillance system. Archived specimens from women age 18-39 years diagnosed with cervical intraepithelial neoplasia grades 2-3 or adenocarcinoma in situ (CIN2þ) were tested for 37 HPV types. We described the proportion and estimated number of cases of CIN2þ by HPV-type groups over time. Trends in HPV16/18-positive CIN2þ were examined, overall and by vaccination status, age, histologic grade, and race/ ethnicity, using Cochrane-Armitage tests.Results: In 10,206 cases, the proportion and estimated number of cases of HPV16/18-positive CIN2þ declined from 52.7% (1,235 cases) in 2008 to 44.1% (819 cases) in 2014 (P < 0.001). Declining trends in the proportion of HPV16/ 18-positive CIN2þ were observed among vaccinated (55.2%-33.3%, P < 0.001) and unvaccinated (51.0%-47.3%, P ¼ 0.03) women; ages 18-20 (48.7%-18.8%, P ¼ 0.02), 21-24 (53.8%-44.0%, P < 0.001), 25-29 (56.9%-42.4%, P < 0.001), and 30-34 (49.8%-45.8%, P ¼ 0.04) years; CIN2 (40.8%-29.9%, P < 0.001) and CIN2/3 (61.8%-46.2%, P < 0.001); non-Hispanic white (59.5%-47.9%, P < 0.001) and non-Hispanic black (40.7%-26.5%, P < 0.001).Conclusions: From 2008-2014, the proportion of HPV16/ 18-positive CIN2þ declined, with the greatest declines in vaccinated women; declines in unvaccinated women suggest herd protection.Impact: The declining proportion of HPV16/18-positive CIN2þ provides additional evidence of vaccine impact in the United States. a "Other" and unknown excluded from analysis (n ¼ 1,437, 14.1%); CIN: cervical intraepithelial neoplasia; AIS: adenocarcinoma in situ with or without CIN. b P < 0.05. c Women with unknown timing of vaccination were excluded (n ¼ 266) McClung et al.

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“…The incidence rate ratio (age-adjusted) dropped significantly from 0.91 to 0.36 in women aged 15–17 years old. Subsequent studies have achieved similar results [56, 57]. More recently, a systematic review confirmed the positive effect of the HPV vaccines against CIN, showing the efficacy of 95% (CIN1+), 97% (CIN2+), and 95% (CIN3+) [58].…”

Section: Data From Real Worldmentioning

confidence: 75%

HPV Vaccine: Updates and Highlights

2019

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HPV is the most common sexually transmitted biological agent and is the cause of many conditions in men and women, including precancer lesions and cancer. Three prophylactic HPV vaccines targeting high-risk HPV types are available in many countries worldwide: 2-, 4- and 9-valent vaccines. All the 3 vaccines use recombinant DNA technology and are prepared from the purified L1 protein that self-assembles to form HPV type-specific empty shells. This non-systematic review aims to summarize the HPV epidemiology and the vaccine development to review the landmark trials of HPV vaccine, to present to most remarkable results from clinical trials and the real world, and to stress the challenges and the barriers for HPV vaccine implementation.

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Ecological Association of Human Papillomavirus Vaccination with Cervical Dysplasia Prevalence in the United States, 2007–2014

Abstract: Decreases in high-grade lesions reflected their greater association with human papillomavirus types 16 and 18, compared with low-grade lesions, providing ecological evidence of population effectiveness of human papillomavirus vaccination among young, privately insured women.

Cited by 43 publications

References 39 publications

Prevalence of Human Papillomavirus Among Females After Vaccine Introduction—National Health and Nutrition Examination Survey, United States, 2003–2014

Prevalence of Human Papillomavirus Among Females After Vaccine Introduction—National Health and Nutrition Examination Survey, United States, 2003–2014

Trends in Human Papillomavirus Vaccine Types 16 and 18 in Cervical Precancers, 2008–2014

HPV Vaccine: Updates and Highlights

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